Uterotonic Medications for Postpartum Hemorrhage: Methylergonovine and Carboprost

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. When uterine atony causes excessive bleeding, uterotonic medications contract the uterus to reduce blood loss. Three uterotonic agents for PPH: 1. Oxytocin (first-line) — already covered separately; given IV after delivery of the placenta 2. Methylergonovine maleate (Methergine) — ergot alkaloid 3. Carboprost tromethamine (Hemabate) — prostaglandin F2α Methylergonovine: - Mechanism: directly stimulates uterine smooth muscle, producing sustained, firm tetanic contraction - Also causes arterial vasoconstriction — this is the safety-limiting factor - PRIORITY ASSESSMENT: Check blood pressure before every dose. Methylergonovine is contraindicated in hypertension, preeclampsia, eclampsia, cardiovascular disease, and peripheral vascular disease — because it worsens all of these via vasoconstriction - Given POSTPARTUM ONLY — never before delivery of the placenta - Can cause severe hypertension, bradycardia, dysrhythmias, myocardial infarction - Client education: report chest pain, headache, shortness of breath, cold/pale extremities Carboprost (Hemabate): - Mechanism: contracts the uterus via prostaglandin F2α receptors - Contraindicated in asthma — prostaglandin F2α causes bronchoconstriction - Adverse effects: fever, tachycardia, nausea, vomiting, diarrhea, hypertension - Monitor vital signs...