Medications for Postpartum Hemorrhage

Medications for Postpartum Hemorrhage

• Ondansetron (Zofran):

  • Routes: PO, IM, IV
  • OB Indications: Nausea and vomiting during labor and postpartum
  • Contraindications: Hypersensitivity to ondansetron
  • Side Effects: Headache, dizziness, constipation
  • Nursing Considerations: Monitor for QT prolongation at high doses
  • Client Teaching: Can be taken with or without food; report severe dizziness

• Carboprost (Hemabate):

  • Route: IM
  • OB Indications: Postpartum hemorrhage due to uterine atony
  • Contraindications: Asthma, pelvic inflammatory disease
  • Side Effects: Nausea, vomiting, diarrhea, fever
  • Nursing Considerations: Monitor for excessive diarrhea; use cautiously in patients with hypertension
  • Client Teaching: Expect flu-like symptoms; notify provider of severe cramping

• Methylergonovine (Methergine):

  • Routes: IM, PO
  • OB Indications: Prevention/treatment of postpartum hemorrhage due to uterine atony or subinvolution
  • Contraindications: Hypertension, preeclampsia
  • Side Effects: Hypertension, nausea, headache
  • Nursing Considerations: Monitor blood pressure closely
  • Client Teaching: Take at the same time each day if prescribed orally

• Docusate Sodium:

  • Route: PO
  • OB Indications: Stool softener to prevent constipation postpartum

Other Medications and Treatments

• Simethicone:

  • Route: PO
  • OB Indications: Relief of postpartum gas pain
  • Contraindications: Hypersensitivity
  • Side Effects: None significant
  • Nursing Considerations: Administer after meals for best effect
  • Client Teaching: Chew tablets thoroughly if applicable

• MMR Vaccine:

  • Route: SQ
  • OB Indications: Given postpartum if mother is not immune to rubella
  • Contraindications: Pregnancy, severe immunodeficiency
  • Side Effects: Fever, rash, joint pain
  • Nursing Considerations: Avoid pregnancy for 1 month after administration
  • Client Teaching: Can cause mild flu-like symptoms; discuss future pregnancy plans

• Rho(D) Immune Globulin (RhoGAM):

  • Route: IM
  • OB Indications: Prevents Rh sensitization in Rh-negative mothers
  • Contraindications: Rh-positive patients
  • Side Effects: Injection site pain, fever
  • Nursing Considerations: Administer within 72 hours of delivery if baby is Rh-positive

• Oxytocin (Pitocin):

  • Routes: IV, IM
  • OB Indications: Induction of labor, postpartum hemorrhage control
  • Contraindications: None for postpartum use
  • Side Effects: Uterine hyperstimulation, hypotension
  • Nursing Considerations: Never administer undiluted IV bolus
  • Client Teaching: Expect uterine cramping as a normal response

• Misoprostol (Cytotec):

  • Routes: Rectal, PO
  • OB Indications: Postpartum hemorrhage management
  • Contraindications: Allergy to prostaglandins
  • Side Effects: Fever, chills, diarrhea
  • Nursing Considerations: Monitor for excessive uterine contractions
  • Client Teaching: Inform of potential flu-like symptoms

• Vitamin K (Phytonadione):

  • Route: IM
  • OB Indications: Prevents hemorrhagic disease of the newborn
  • Contraindications: Hypersensitivity to vitamin K
  • Side Effects: Pain at injection site, rare allergic reactions
  • Nursing Considerations: Administer within 1 hour of birth in the vastus lateralis
  • Client Teaching: Essential for newborn clotting; explain importance to parents

• Erythromycin Ophthalmic Ointment:

  • Route: Ophthalmic
  • OB Indications: Prevents neonatal conjunctivitis from gonorrhea and chlamydia
  • Contraindications: Hypersensitivity to erythromycin
  • Side Effects: Mild eye irritation, blurred vision
  • Nursing Considerations: Apply a thin ribbon in each eye within 1-2 hours of birth
  • Client Teaching: Temporary eye blurriness is normal; do not wipe off immediately

• Hepatitis B Vaccine:

  • Route: IM
  • OB Indications: Prevents hepatitis B infection
  • Contraindications: Severe allergy to yeast or vaccine components
  • Side Effects: Low-grade fever, injection site redness
  • Nursing Considerations: Requires parental consent; administer in opposite leg from vitamin K
  • Client Teaching: Given at birth, 1-2 months, and 6 months; mild discomfort expected

• Hepatitis B Immune Globulin (HBIG):

  • Route: IM
  • OB Indications: Given to infants born to hepatitis B-positive mothers
  • Contraindications: Severe allergic reaction to immune globulin
  • Side Effects: Injection site pain, fatigue
  • Nursing Considerations: Administer within 12 hours of birth; give in opposite leg from vaccine
  • Client Teaching: Provides immediate passive immunity while vaccine builds long-term protection

• Naloxone (Narcan):

  • Routes: IV, IM, SQ, ET
  • OB Indications: Reverses respiratory depression in newborns due to maternal opioid use
  • Contraindications: Neonates of opioid-dependent mothers (can cause withdrawal)
  • Side Effects: Increased heart rate, nausea, irritability
  • Nursing Considerations: Monitor respiratory status closely
  • Client Teaching: Emergency medication; explain purpose if used

• Morphine (for Neonatal Abstinence Syndrome):

  • Route: PO
  • OB Indications: Treats withdrawal symptoms in opioid-exposed newborns
  • Contraindications: Severe respiratory depression, allergy to morphine
  • Side Effects: Drowsiness, constipation, respiratory depression
  • Nursing Considerations: Monitor for signs of oversedation and withdrawal symptoms
  • Client Teaching: Used for controlled weaning; parents should expect drowsiness

• Ampicillin:

  • Route: IV, IM
  • OB Indications: Prophylaxis for neonatal sepsis, especially in suspected GBS cases
  • Contraindications: Allergy to penicillins
  • Side Effects: Rash, diarrhea, hypersensitivity reactions
  • Nursing Considerations: Monitor for allergic reactions and effectiveness
  • Client Teaching: Part of standard newborn infection prevention

• Gentamicin:

  • Route: IV, IM
  • OB Indications: Used in conjunction with ampicillin for neonatal sepsis
  • Contraindications: Allergy to aminoglycosides
  • Side Effects: Nephrotoxicity, ototoxicity, dizziness
  • Nursing Considerations: Monitor kidney function and hearing in long-term use
  • Client Teaching: Given only when infection is suspected; explain importance to parents

• Ketorolac (Toradol):

  • Routes: IV, IM, PO
  • OB Indications: Short-term management of moderate to severe postpartum pain
  • Contraindications: Hypersensitivity to NSAIDs, active bleeding disorders, renal impairment, postpartum hemorrhage
  • Side Effects: GI bleeding, nausea, dyspepsia, headache, dizziness, renal impairment
  • Nursing Considerations: Monitor for signs of bleeding, assess renal function, avoid use beyond 5 days due to increased risk of renal and GI complications
  • Client Teaching: Take with food to minimize GI upset, report signs of bleeding or persistent pain, avoid concurrent use with other NSAIDs