Antibiotic Prophylaxis for Postpartum Uterine Examination

Alternative Regimen for Penicillin Allergy

• For patients with non-severe penicillin allergy, substitute cefazolin 1 g IV for ampicillin, maintaining metronidazole 500 mg IV, as recommended by the American College of Obstetricians and Gynecologists 1
• For patients with severe penicillin allergy, use clindamycin 900 mg IV plus an aminoglycoside, such as gentamicin 5 mg/kg IV, as alternatives, according to the American College of Obstetricians and Gynecologists 1

Special Circumstance: Prior GBS Prophylaxis

• GBS prophylaxis regimens include penicillin G 5 million units IV initially then 2.5 million units IV every 4 hours, or ampicillin 2 g IV initially then 1 g IV every 4 hours, as stated by the American College of Obstetricians and Gynecologists 2

Additional Considerations for PPH Management

• If bleeding persists after oxytocin, administer tranexamic acid 1 g IV within 3 hours of delivery, with a second dose available 0.5-23.5 hours later if bleeding continues, as recommended by the American College of Obstetricians and Gynecologists 3
• Maintain fibrinogen levels ≥2 g/L during active hemorrhage and target hemoglobin >8 g/dL with transfusion as needed, according to the American College of Obstetricians and Gynecologists 3