Management of Postpartum Hemorrhage and Uterotonic Use

Introduction to Contraindications and Precautions

Ergometrine is contraindicated in patients with hypertension, pre-eclampsia/eclampsia, cardiovascular disease, respiratory disease (particularly asthma), sepsis, and hypersensitivity to the drug, as stated by the European Respiratory Journal and European Heart Journal guidelines 1, 2
The use of ergometrine should be avoided in patients with coronary artery disease and cerebrovascular disease due to the risk of vasoconstriction and ischemia, as recommended by the European Heart Journal guidelines 2

Asthma and other respiratory diseases are contraindications for ergometrine use, as it can trigger bronchospasm, particularly when used with general anesthetics, according to the European Respiratory Journal guidelines 1
Oxytocin is preferred over ergometrine for prevention of postpartum hemorrhage in women with respiratory disease, as it has not been associated with worsening lung function or asthma exacerbation, as recommended by the European Respiratory Journal and other sources 1, 3
Prostaglandin F2a should be avoided in women with asthma as it may cause bronchoconstriction, as reported by the European Respiratory Journal 1

Ergometrine can cause coronary vasospasm and ischemia, making it a concern for patients with cardiovascular disease, as reported in the Pharmacological Research journal 4
For women with cardiac disease, including peripartum cardiomyopathy, a single dose of intramuscular oxytocin can be used for active management of the third stage, as suggested by the European Journal of Heart Failure 5

Oxytocin is preferred over ergometrine for prevention of postpartum hemorrhage, particularly in women with respiratory or cardiovascular disease, as recommended by the European Respiratory Journal guidelines 1
Active management of the third stage of labor should use oxytocin without ergometrine in women with lung disease, according to the European Respiratory Journal guidelines 1
Administering IV oxytocin immediately after delivery of the fetus is a recommended step in managing postpartum hemorrhage, with a typical dose of 10 IU 6
For severe and uncontrollable postpartum hemorrhage, consider tranexamic acid 1 g IV within 1-3 hours of bleeding onset, as recommended by Anaesthesia 7

When ergometrine must be used, monitor blood pressure closely, watch for signs of vasospasm, be alert for respiratory distress, and observe for signs of eclampsia if there's any possibility of undiagnosed pre-eclampsia, as recommended by the European Respiratory Journal guidelines 1
The primary physiologic mechanism to stem bleeding from the placental bed after separation of the placenta is sustained myometrial contraction leading to occlusion of uterine blood vessels, and oxytocin enhances uterine contraction and promotes placental separation 6