Pharmacologic interventions | |
Drug | Dosing |
Oxytocin (first-line) | 10 to 40 units in 500 to 1000 mL normal saline infused at a rate sufficient to control atony or 5 to 10 units IM. |
Tranexamic acid (adjunctive agent) | 1 g (10 mL of a 100 mg/mL solution) is infused over 10 to 20 minutes; if bleeding persists after 30 minutes, a second 1 g dose is administered. |
Ergots (second-line) | Methylergonovine 0.2 mg IM or ergonovine 0.2 mg IM every 2 to 4 hours. |
Carboprost (second-line) | 0.25 mg IM every 15 to 90 minutes up to 8 doses. |
Misoprostol | 400 to 800 mcg sublingually as a single dose. |
Recombinant human factor VIIa (adjunctive agent) | 50 to 100 mcg/kg. It is preferable to start with a low dose (40 or 60 mcg/kg). The dose may be repeated once in 15 to 30 minutes if there is no response. Additional doses are unlikely to be effective. |
Surgical interventions | |
Repair lacerations | |
Curettage | |
Uterine compression suture (eg, B-Lynch suture) | |
Uterine artery ligation | |
Utero-ovarian artery ligation or cross clamp | |
Pelvic packing | |
Uterine tourniquet | |
Focal myometrial excision | |
Use of fibrin glues and patches to cover areas of oozing and promote clotting | |
Placement of figure 8 sutures or other hemostatic sutures directly into the placental bed | |
Resuscitative endovascular balloon occlusion of the aorta (REBOA) | |
Internal iliac artery (hypogastric artery) ligation | |
Aortic/iliac artery compression | |
Hysterectomy, supracervical | |
Hysterectomy, total | |
Interventional endovascular procedures | |
Selective arterial embolization | |
Intermittent aortic balloon occlusion | |
Common iliac artery balloon occlusion | |
Blood bank | |
Packed red blood cells | |
Platelets | |
Fresh frozen plasma | |
Cryoprecipitate | |
Nonsurgical interventions | |
Uterine massage | |
Intravenous fluids | |
Intrauterine tamponade | |
Intrauterine balloon or alternative device (eg, bladder catheter bulb, Sengstaken-Blakemore tube) | |
Intrauterine vacuum | |
Uterine packing (eg, 4-inch gauge packing) | |
Consultations | |
General surgery | |
Trauma surgery | |
Anesthesia team | |
Interventional radiology | |
Gynecologic oncology | |
Urology |
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