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Uterotonics & Adjuncts — Dosing Guide
For use by obstetric clinicians. Doses reflect common U.S. practice; always follow your local formulary, pharmacy policy, and PPH protocol.
Professional use
Verify dosing against current labeling and institutional protocols. Adjust for patient-specific contraindications and comorbidities (e.g., hypertension, asthma).
| Medication | Dose & Route | Notes / Contraindications |
|---|---|---|
| Oxytocin |
IV bolus 10 IU slow (or IM 10 IU if no IV). Infusion: 10–40 IU in 1 L NS/LR titrated per protocol. |
First-line uterotonic. Avoid rapid IV push (risk hypotension/tachycardia). Monitor uterine tone and response. |
| Methylergonovine (Methergine) |
0.2 mg IM every 2–4 hours as needed. | Avoid in hypertension/preeclampsia and significant cardiovascular disease. |
| Carboprost (Hemabate) |
250 mcg IM every 15–90 min; max ~2 mg total. | Caution/avoid in asthma (bronchospasm risk) and pulmonary hypertension; GI/fever common. |
| Misoprostol | 600–1000 mcg PR / SL / PO (per protocol). | Adjunctive option; useful when IV access limited. Fever, shivering, diarrhea more common at higher doses. |
| Tranexamic acid (TXA) |
1 g IV over 10 minutes once PPH diagnosed; repeat 1 g after 30 min–24 hr if bleeding persists (protocol-dependent). |
Most effective if given within 3 hours of birth. Avoid in active thromboembolism; consider risk/benefit with prior VTE. |
| Cryoprecipitate / Fibrinogen concentrate | Replace to maintain fibrinogen > 200 mg/dL (or per ROTEM/TEG / local protocol). | Key in severe PPH/DIC. Consider early replacement as fibrinogen can drop early in obstetric hemorrhage. |
| Packed RBCs | Transfuse based on ongoing loss/instability; ~1 g/dL Hgb increase per unit (typical adult). | In rapid bleeding, use as part of MTP with balanced component therapy rather than RBC-only resuscitation. |
| Platelets | Maintain platelets > 50,000/µL during active bleeding or major surgery (institution-dependent). | Higher targets may be used in major surgery, ongoing coagulopathy, or per viscoelastic testing. |
| Plasma (FFP) |
Often 10–15 mL/kg (or per massive transfusion ratio / lab targets). | Guided by PT/INR/aPTT and clinical bleeding. Use warmed products to reduce hypothermia risk. |
Tip: On phones, swipe the table left/right. Consider linking each medication to your dedicated OBPharm/OBRx monograph page if available.
Disclaimer
For use by medical professionals. This quick guide supports, but does not replace, institutional protocols or clinical judgment.
UPDATED: 2025