Uterine Atony Meds Flashcards
How much can atonic uterus lose?
up to 2 liters of blood in 5 minutes
Uterine massage
Massage uterus plus medications to promote contraction
1 cause of PPH
Most common cause of postpartum hemorrhage is UTERINE ATONY. Initiate MTP(massive transfusion protocol) with massive hemorrhage.
1st line treatment?
Oxytocin:(Pitocin) 1st line tx
Oxytocin - dosing
30 units in 500cc IV drip Lactated Ringers premix.
Oxytocin - MOA
Hormone peptide formed from 9 amino acids (released from posterior pituitary).
As medication: Increases intracellular calcium in uterine myofibrils. Also increases local prostaglandin production.
Oxytocin - onset, DOA, excretion
Onset: 1 min
1/2 life: 3-5 minutes
Excretion: urine
Oxytocin - side effects
systemic vasodilator –> can aggravate hypotension
Rare: arrhythmias
2nd line tx?
Methylergonovine (Methergine): Ergot alkaloid
Methergine - administration
Administer INTRAMUSCULARLY- quadriceps or deltoid IM only dose is .2mg IM
IM dose can be repeated 2-4 hours
(Refrigerated)
Methergine: MOA
Enhances uterine contractility and causes vasoconstriction. Contracts upper and lower uterus simultaneously
Methergine - metabolism
Liver
Methergine - side effects
Often increases blood pressure
Other rare side effects: N/V, pulmonary edema, coronary vasospasm/ Myocardial infarction.
Methergine - contraindications
Contraind in Preeclamptic or Hypertension.
Relative contraindication: coronary artery disease.
Methergine - contraindications
Contraind in Preeclamptic or Hypertension.
Relative contraindication: coronary artery disease.
3rd line tx?
Carboprost (Hemabate): 15-methyl prostaglandin F2 alpha.
Hemabate - admin
INTRAMYOMETRIALLY IM dose .25mg…..dose can be repeated every 15 minutes to total of 2mg.
Carboprost (Hemabate): contraindications
Asthmatics d/t Known abnormal ventilation perfusion ratios, hypoxemia.
Carboprost (Hemabate): side effects
Diarrhea, tachycardia, fever.
Carboprost (Hemabate): contraindications
Relative contraindication: hepatic, cardiac, renal disease.
4th line tx
Misoprostol(Cytotec): Prostaglandin E1 analog
Misoprostol (Cytotec): admin
OFF LABEL used RECTALLY 800-1000mcg
Misoprostol (Cytotec): side effects
Diarrhea (10%), abdominal pain, dyspepsia
Misoprostol (Cytotec): onset, DOA
Rectal dose onset one hour with DOA of 4 hours (Sublingual in literature 400mcg SL with 30 min onset and DOA of 2 hours)
TXA drug class
TXA is antifibrinolytic-synthetic analog of Lysine amino acid
TXA dosing
1 gram diluted IVPB in 100cc NS over 10 minutes then infuse 1 gram IV infusion in 250cc NS over 8 hours
Fibrinogen Concentrate (RiaSTAP®) admin
Riastap has fibrinogen and human albumin within it): Reconstitute each vial with 50 mL Sterile Water for Injection. Gently swirl vial to ensure product is fully dissolved. Do NOT shake. Reconstituted solution should be colorless and clear to slightly opalescent
Fibrinogen Concentrate - admin
Administration Instructions: Attach hanging device to vial. Insert dispensing pin into vial to allow for venting. Attach tubing. Each vial (50 mL) to be infused over 10 minutes (5 mL/min). One dose = 2 vials = approximately 2000 mg. No thawing and fast to administer.
Fibrinogen Levels
Key new concept: Keep fibrinogen levels greater than 200mg/dL….Fibrinogen levels fall critically low earlier than other coagulation factors during post partum hemorrhage.
Give within 3hr PPH
