Many hospitals have created their own unique protocol to address

Many hospitals have created their own unique protocol to address this aspect of management, such as Vanderbilt University Medical Center, which has published their hospital’s guidelines: for the first round of transfusion, 10 units of non-irradiated, uncrossed packed red blood cells, 4 units of AB negative plasma and 2 units of single donor platelets are sent by the blood bank; then for continued hemorrhage, bundles of blood products are sent containing 6 units of non-irradiated PRBCs, 4 units of thawed plasma and 2 units of single donor platelets [18]. in obstetrical patients if transfusion

is needed before type specific C188-9 or crossmatched blood can be obtained, if possible type-O, Rh-negative blood should be utilized because of future risk of Rh sensitization; however if not readily available

Rh-positive blood should not be withheld if clinically required. The surgeon must be aware that hemolytic transfusion reactions with emergency non typed blood can reach up to 5% [19]. Escalated Medical Management If initial interventions fail to control postpartum hemorrhage, a stepwise progression of medical therapy is available using uterotonics to facilitate contraction of the uterus. The first agent used is oxytocin. In the United States, oxytocin is typically administered after delivery of the placenta dosed at 10-20 units in 1000 mL of crystalloid solution, given intravenously (IV) and titrated to an in infusion

rate that achieves adequate uterine contractions. Less commonly, pheromone it can be given intramuscularly (IM) or intrauterine (IU). It is common practice to double the oxytocin in PPH, i.e., 40 units in 1 L, and safety/efficacy has been documented up to 80 units per liter of crystalloid [20]. Oxytocin is not bolused, as boluses can cause hypotension. Excessive oxytocin can cause water intoxication, as it resembles antidiuretic hormone. If there is not adequate uterine tone with oxytocin, the second line agent used will depend on the medications’ side effects and contraindications. Two classes of drugs are available: ergot alkaloids (methylergonovine) or prostaglandins (PGF2α, PGE1, and PGE2). Methylergonovine may be used, dosed as 0.2 mg IM and repeated 2-4 hrs later, as long as the patient does not have hypertension or preeclampsia. If the patient has contraindications to methylergonovine or if the hemorrhage is still non-responsive, 250 μg of 15-methylprostagandin F2α may be injected intramuscularly (IM) up to 3 times at 15-20 minute intervals (maximum dose 2 mg) [21]. Appropriate injection points include thigh, gluteal muscle or directly into the myometrium.

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