Pregnancy: Asthma + uterine atony


Postpartum hemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery. It is a major cause of maternal morbidity, one of the top three causes of maternal mortality in both high and low per capita income countries. The incidence of PPH varies widely, depending upon the criteria to define the disorder. A reasonable estimate is 1-5% of deliveries. Uterine atony is the most common cause of PPH and accounted for most of the increase in PPH seen in recent years. Definition and diagnosis of PPH are defined as follows: PPH is estimated blood loss greater than or equal to 500 ml after vaginal birth or greater than or equal to 1000 ml after cesarean delivery, but more commonly defined and diagnosed clinically as excessive bleeding that makes the patient symptomatic: pallor, lightheadedness, weakness, palpitations, diaphoresis, restlessness, confusion, air hunger, syncope, and/or results in hypovolemia – hypotension, tachycardia, oliguria, low oxygen saturation. 
Atony – The most common cause of PPH is uterine atony, complicates 1 in 20 births and is responsible for at least 80% of cases of PPH. Correlates of atonic uterus include : overdistension, uterine infection, drugs, uterine fatigue uterine inversion retained placenta or placental fragments.

MGMT – initial interventions include : fundal massage, IV access, lab tests.

uterotonic drugs: oxytocin 40 units in 1 liter, methylergonovine 0.2 mg intramuscularly never IV, Misoprostol PGE1, Carboprost tromethamine – 15 methyl-PGF2alpha – Hemabate – 250 mcg IM every 15-90 min. If no asthma!

Hemabate has been shown to incite as well as exacerbate asthma. Thus, its use in asthmatic patients should be very carefully considered. 


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