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Postop uterine atony: Causes

Most common cause of postpartum hemorrhage. Treated with synthetic oxytocins (ex. oxytocin injection, Pitocin®), which do NOT contain vasopressin – if given rapidly (ex. 10 U Pitocin® rapidly, despite that the manufacture recommends only 5 U slowly), these agents can cause vasodilation/hypotension and tachycardia [Pinder AJ et al. Int J Obstetr Anesth 11: 156, 2002]. 10 – 15 units should be given in 500 cc of crytalloid, slowly titrated to effect. If unhelpful, consider methylergonovine (0.2 mg IM, contraindicated in preeclampsia), prostaglandin F2α (0.25 mg IM, may increase airway resistance), or misoprostol (prostaglandin E1 analog).

Uterine Atony

  • 10-20 U Pitocin® infusion over 10 mins
  • Methylergonovine 0.2 mg IM (contraindicated in preeclampsia)
  • Prostaglandin F2α (0.25 mg IM, may increase airway resistance)
  • Misoprostol