How to Prevent and Treat Postpartum Hemorrhage2



Get uterine massage to help alleviate bleeding.,
Use oxytocin to contract middle layer of the uterine wall.,
Get ergot alkaloids administered to induce contractions.,
Take prostaglandins to increase vasoconstriction (tightening of blood vessels).,
Receive sutures to stop severe bleeding.,
Make sure the uterus is properly positioned.

Uterine massage is performed by your OBGYN placing one hand in your vagina and other hand on your abdominal wall.

One hand compresses area above your abdominal wall, while the other hand is in your vagina.
The back part of your uterus is massaged with the abdominal hand while the front is massaged using the vaginal hand.

, Oxytocin is able to stimulate the upper part of your myometrium (middle layer of the uterine wall) causing it to contract rhythmically.

This constricts the arteries in the area, resulting in a decreased blood flow to your uterus.
Oxytocin is the drug of choice for the treatment of post-partum hemorrhage.
Generally, 10 IU is injected intramuscularly or 20 IU is infused with 1 liter (0.3 US gal) of saline using a rate of 250 ml per hour, applied intravenously.
In some instances, 500 ml can be infused over a period of 10 minutes without causing further complications.

, Ergot alkaloid medications, like methylergonovine and ergometrine, cause smooth muscle contraction in your uterus.

This can have a similar effect to oxytocin, working to reduce blood flow to the uterus and preventing further blood loss.
Generally, methylergonovine is administered intramuscularly at a dose of 0.2 mg.
The dose can be repeated every two to four hours.
Since this drug can raise blood pressure, it is not given to women who have pregnancy induced hypertension (preeclampsia) or hypertension.
You should watch for side effects that include nausea and vomiting.

, Prostaglandins are can increase your uterine contractions and cause vasoconstriction in your blood vessels.

15-methyl prostaglandin F2 and carboprost (Hemabate) are commonly used prostaglandins.
Keep an eye on the following side effects: nausea and vomiting, hypertension, diarrhea, headache, and pyrexia (fever).
Another prostaglandin used is misoprostol.
This drug is able to increase uterine tone, while decreasing postpartum bleeding.
Misoprostol is administered orally, sublingually, rectally, and vaginally.
The usual doses range from 200 to 1000 mcg.
This drug is not approved by the American Food and Drug Administration because of the side effects (fever, diarrhea, and shivering).

, Postpartum hemorrhage caused by trauma can usually be managed through hemostasis (termination of bleeding using chemical or mechanical means) and immediate repair.

However, in some cases, direct pressure is not able to stop bleeding.
You then need to receive sutures.

, Every attempt must be made in order to reverse the uterus if it has become inverted.

Once the uterus is put back in place, you must administer uterotonic agents to promote uterine tone elasticity and to prevent a recurrence from happening.
In cases where the initial attempt at replacing the uterus fails, magnesium sulfate administration, nitroglycerin, terbutaline, and general anesthesia can be used in order to allow enough uterine relaxation for manipulation to take place.
If all else fails, surgical replacement of the uterus can be done.

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