Management of Postpartum Hemorrhage

Contraindications and Recommendations

Methylergonovine is contraindicated for treatment of uterine atony after delivery due to the significant risk (>10%) of vasoconstriction and hypertension, as recommended by the European Society of Cardiology 1, 2
The European Society of Cardiology recommends a slow IV infusion of oxytocin (<2 U/min) as the first-line treatment to prevent maternal hemorrhage after placental delivery, which avoids systemic hypotension while promoting uterine contraction 1, 2
The World Health Organization suggests that prostaglandin F analogues are useful for treating postpartum hemorrhage unless an increase in pulmonary artery pressure is undesirable, as stated in the European Heart Journal 1, 2
The American College of Obstetricians and Gynecologists recommends that tranexamic acid should be considered as part of standard treatment for postpartum hemorrhage, administered within 3 hours of birth at a fixed dose of 1g IV over 10 minutes, based on findings from The Lancet Global Health 3, 4

The American Heart Association recommends that hemodynamic monitoring should be continued for at least 24 hours after delivery, particularly in women with structural heart disease, as stated in the European Heart Journal 1, 2
The European Society of Cardiology suggests that careful monitoring is required when any uterotonic is used due to potential hemodynamic effects 1
Non-surgical interventions such as bimanual compression, intrauterine balloon tamponade, non-pneumatic antishock garment, and external aortic compression can be considered if bleeding persists, as recommended by The Lancet Global Health 3
Surgical interventions such as brace sutures, arterial ligation, or hysterectomy may be necessary in refractory cases, as stated in The Lancet Global Health 3

Methylergonovine (ergometrine) should not be used in women with asthma because it precipitates bronchospasm, especially when administered together with general anesthetic agents; the European Respiratory Society/TSANZ guidelines explicitly advise against its use in this population. 5
Carboprost (prostaglandin F₂α) is contraindicated for asthmatic postpartum patients, as it induces bronchoconstriction and the European Respiratory Society/TSANZ guidelines recommend avoiding it in women with asthma. 5

Uterine balloon tamponade is the preferred next‑step intervention after failure of oxytocin and uterine massage in asthmatic women with postpartum hemorrhage, providing a high success rate (≈90 % when correctly placed) while avoiding pharmacologic triggers of bronchospasm. 5

Tranexamic acid, administered intravenously within three hours of delivery, reduces bleeding‑related mortality and is considered safe for patients with asthma. 6