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Table 3-2

Medical Management of Postpartum Hemorrhage With Uterotonic Agentsa

AgentDoseComments and Contraindications
Oxytocin (Pitocin)10-40 U/L IV at 120 mL/h or 10 U IM

  • Do not give undiluted IV bolus.

  • Antidiuretic effect with prolonged infusion or high dose; can cause volume overload

Methylergonovine maleate (Methergine)0.2 mg IM every 2-4 h or 0.2 mg orally every 6 hAvoid in patients with hypertension, preeclampsia, or Raynaud phenomenon.
Do not start orally until 4 h after last parenteral dose.May cause nausea and vomiting
15-Methyl prostaglandin F2α (Hemabate)0.25 mg IM (skeletal or myometrium) every 15-90 min to a maximum of 8 doses

  • Avoid in patients with asthma.

  • Renal, hepatic, and cardiac diseases are relative contraindications.

  • May cause nausea/vomiting, tachycardia, diarrhea, pyrexia

Prostaglandin E1 analog (misoprostol [Cytotec])800-1000 μg orally, sublingually, or rectally; onceMay cause nausea, vomiting, diarrhea, fever, shivering, headache

Abbreviations: IM, intramuscular; IV, intravenous.


aAdapted with permission from American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186. Copyright © 2017 by The American College of Obstetricians and Gynecologists.