PostPartum Hemorrhage in patient with decreased Uterine Tone

Clinic A/P, adults, OB/GYN, Pharmacy and Therapeutics

 

Uterotonic agents for treating PPH 2/2 to uterine atony

  1. Oxytocin (Pitocin) — 1st line agent.
  2. Misoprostol (Cytotec)
  3. Methylergonovine – CONTRAINDICATED in patients with any degree of HTN or history of HTN
  4. Carboprost (Hemabate) – CONTRAINDICATED in patients with asthma. Also, should be avoided in patients with hepatic, renal, or cardiac disease.

Oxytocin and Misoprostol do not have any contraindications.

Mechanism of Action

  • Methylergonovine is an ergot alkaloid that causes generalized smooth muscle contraction and can raise blood pressure.
  • Carboprost (Hemabate) is a synthetic prostaglandin. It stimulates smooth muscle and uterine contractions.
  • Misoprostol, a prostaglandin analog, binds to myometrial cells to cause strong myometrial contractions leading to the expulsion of tissue.
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