Table 31-1 "Utfti%Stimdlants?Usso-PieveitadlManage'UtfAtpn?

Drug
Oxytocin (Pitocin,

'

! . m . _ _

Dosing Information
IVuse: 10to 40 units in 500 to 1000 mLcrystalloid uid at 50 milliunits/min administration rate. Onset: immediate. Duration: 1 hr. Il/bolus administration not recommended. IM use: 10units. Onset: 3 to 5 min. Duration: 2 to 3 hr.
IM use: 0.2 mgq2!4hr. Onset: 2 to 5 min. Duration: 3 hr (for 5 dose maximum). P0use: 0.2 mg q4hr (for 6 doses). Onset: 7 to 15 min. Duration:3 hr (for 1 week). IVadministration not recommended.

Contraindications
None for use in

Expected Effects
Rhythmic uterine contrac" tions that help to prevent or reverse postpartum hemorrhage caused by uterine atony.

Side Effects
Uterine hyperstimulation, mild transient hypertension, water intoxication rare in postpartumuse.

Syntocinon)

postpartum hemorrhage. Avoid undiluted rapid Iv infusion, which causes hypotension.

Methylergonovine

Women with labile or high

maleate (Methergine)

blood pressure,known sensitivity to drug, or cardiac disease. Use with caution during

lactation.

Sustaineduterine contractionsthat help to prevent or reverse postpartumhemorrhage caused by uterine atony; managementof postpartumsubinvolution. Sustaineduterine contractionsthat help to prevent or reverse postpartum hemorrhage caused by uterine atony;
management of postpartumsubinvolution.

Hypertension,dizziness. headache, ushing/hot ashes, tinnitus, nausea and vomiting, palpitations, chest pain. Overdose or hypersensitivity is recognized byseizures; tingling and numbnessof ngers and toes. Hypertension,dizziness, head" ache, nausea and vomiting, chest pain. Hypersensitivityis noted by systemic vasoconstrlctive effects: seizure, chest pain, gen" eral weakness,and tingling and numbness of ngers and toes that leads rarely to gangrene.

Ergonovine mateate (Ergotrate Maleate)

IM use: 0.2 mgq2!4hr. ' women in} labileor high Onset: 7 min. Duration:3 hr blood pressure or known (5 dose maximum). sensitivity to drug. POuse: 0.2 mgq6!12hr. Onset: 15 min. Duration: 3 hr (for 2~7 days). Il/ administration not

recommended.
Prostaglandin
(PGFz, carboprost

lM use: 0.25 mg15!90 min,

repeatedupto maximum 8 doses. Physician may elect to administer by direct intramyometriat injection.

Women with active

tromethamine [Hemabate], Prostin/15M)

cardiovascular, renal, liver disease, or asthma or with known hypersensitivity to drug.

Control of refractory cases Nausea,vomiting, diarrhea, of postpartum hemorrhage headache, ushing, bradycardia, caused byuterine atony; bronchospasm,wheezing, cough, generally used after failed chills, fever. attempts at control of hemorrhage with oxytocic agents.
Used to prevent and treat uterine atony after failed

Misoprostol
(Cytotec)

800!1000 mcg rectally.

History of allergies to prostaglandins.

Diarrhea, abdominal pain, headache.

attempts to control bleeding with oxytocics.

Dinoprostone (Prostin E2)
Suppository (vaginally or rectally) 20 mcg every 2 hr. Store frozen!must be thawed to room temperature.

Avoid if woman is hypotensive,or has asthma or acute Inammatory disease.

Stimulate uterine contractions.

Fever is common and occurs within 15!45 min of insertion; bleeding, abdominal cramps, NN.

IMPLICATIONSFOR NURSING MANAGEMENT OFTHE PUSTPARTUMWOMAN RECElVING UTERINESTIMULANTS

I 1Assess fundus for evidence of contraction and amount of uterine bleeding at least q10!15 min X 1!2 hr after administration, then q30!60min until stable. More frequent assessments are determined by the woman's condition or by orders of the physician/CHM. rt Assess blood loss by hematocrit and hemoglobin levels. n Monitor pulse and blood pressure q15min for at least 1 hr after administration, then q30!60min until stable. 1- Apply pulse oximeter and administer oxygen according to agency protocol. .2 Weigh peripads or chux dressing. : 1 Note expectedduration of action of drug being administered, and take care to recheck fundus at that time. s; When the drug is ineffective, the fundus remains atonic (boggy or uncontracted), and bleeding continues. Massagethe fundus. If massage fails to cause sustained contraction, notify the physician/CNM immediately. e Monitor woman for signs of known side effects of the drug; report to physician/CNMif side effects occur. 1: Continuous EKG monitoring may be indicated for hypotension, continuous bleeding, tachycardia, or shock. :i Elevate the legs to a 20- to 30-degree angle to increase venous return. ;: Remind the woman and her support person that uterine cramping is an expected result of these drugs and that medication is available for discomfort. Administer analgesic medicationsas needed for pain relief. Provide nonpharmacologic comfort measures. It analgesic medication ordered is insufcient for pain relief, notify the physician/CNM.Provide information to patient and family regarding importance of not smoking during Methergine administration (nicotine from cigarettes leads to constricted vessels and may lead to hypertension) and signs of toxicity.
WHEN PROSTAGLANDINIS USED

:- Check temperature q1!2hr and/or after chill. Administer antipyretic medication as ordered for prostaglandin-induced fever. l ~ Auscultate breath sounds frequently for signs of adverse respiratory effects. I: Assess for nausea,vomiting, and diarrhea. Administer antiemetic and antidiarrheal medications as ordered. (In some settings, women are premedlcated with these drugs.)