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