Drug

Indication

Dose

Route of Administration

Duration of Treatment

Phylloquinone

(Vitamin K₁)

Prophylaxis for Vitamin K

deficiency

bleeding

1 mg

Intramuscularly

1 dose

Oxytocin (Pitocin)

Postpartum

hemorrhage only

10 units/ml

Intramuscularly

only

1-2 doses. Transport to

hospital required if more

than two (2) doses are

administered.

Misoprostol

Note: This is an appropriate off label use of this drug.

Postpartum

hemorrhage only

200 microgram

tabs, at 800

micrograms per

dose (4 tabs)

Rectal or

sublingual, or

may be used as

½ rectally and

½ sublingually

1-2 doses. Transport to

hospital required if more than

2 doses are administered. Not to exceed 800 micrograms.

Methylergonovine

(Methergine)

Postpartum

hemorrhage only

0.2mg

Intramuscular

or orally

Single dose. Every six hours, may repeat

3 times. Contraindicated in hypertension and Raynaud's Disease.

Lidocaine HCL

1% or 2%

Local anesthetic for use during postpartum repair

of lacerations or episiotomy

Maximum 50 ml (1%)

Maximum 15 ml (2%)

Precutaneous infiltration only

Completion of repair

Penicillin G

(Recommended)

Group B Strep

Prophylaxis

5 million units initial dose, then 2.5 million units every 4 hours until birth

IV in > 100 ml LR, NS or

D₅LR

Until birth of baby

Ampicillin

Sodium

(Alternative)

Group B Strep

Prophylaxis

2 grams initial dose, then 1 gram every 4 hours until birth

IV in > 100ml NS

Until birth of baby

Cefazolin Sodium

Group B Strep

Prophylaxis

2 grams initial dose, then 1 gram every 8 hours

IV in > 100 ml LR, NS or

D₅LR

Until birth of baby

Clindamycin

Phosphate

Group B Strep Prophylaxis

900 mg every 8 hours

IV in > 100 ml

NS or LR

Until birth of baby

Lactated Ringers

(LR)

To administer group B Strep Prophylaxis

Intravenous catheter

5% Dextrose in

Lactated Ringer's

solution (D₅LR)

To administer

group B Strep

Prophylaxis

Intravenous

catheter

0.9% Sodium

Chloride (NS)

To administer group B Strep Prophylaxis

Intravenous catheter

Oxygen

Maternal/Fetal Distress, or Neonatal Resuscitation

10-12 L/min

10 L/min

Mask or bag and mask

Until stabilization is achieved or transfer to a hospital is complete

0.5%

Erythromycin Ophthalmic Ointment

Prophylaxis of Neonatal Opthalmia

1 cm ribbon in each eye

Topical

1 dose

Rh(D) Immune Globulin

Prevention of RH(D) sensitization in Rh(D) negative women

300 mcg

Intramuscularly

Single dose at any gestation for Rh(D) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma.

Single dose at 26-28 weeks gestation for Rh(D) negative, antibody negative women.

Single dose for Rh(D) negative, antibody negative women within 72 hours of delivery of Rh(D) positive infant, or infant with unknown blood type.

Tranexamic Acid (TXA)

Postpartum Hemorrhage

To be used when initial anti-hemorrhagic therapies fail and with notification of local medical support

100 mg/ml (1g)

IV at 1 ml per minute

2nd dose if bleeding continues past 30 min or restarts within 24 hours

IV Fluids

·Lactate Ringers (LR)

·.45% Saline

·.9% Normal Saline

Postpartum Hemorrhage

Infuse 1 liter at wide-open rate

IV line with 16-18 gauge needle

After first liter, a second liter may be titrated to client's condition. With the start of the second liter, transport to hospital is required and local medical support will be notified.