Version June 2024
| Pharmacologic interventions | |
| Drug | Dosing |
| Oxytocin (first-line) | 10 to 40 units in 500 to 1000 mL normal saline infused at a rate sufficient to control atony or 5 to 10 units IM. |
| Tranexamic acid (adjunctive agent) | 1 g (10 mL of a 100 mg/mL solution) is infused over 10 to 20 minutes; if bleeding persists after 30 minutes, a second 1 g dose is administered. |
| Ergots (second-line) | Methylergonovine 0.2 mg IM or ergonovine 0.2 mg IM every 2 to 4 hours. |
| Carboprost (second-line) | 0.25 mg IM every 15 to 90 minutes up to 8 doses. |
| Misoprostol | 400 to 800 mcg sublingually as a single dose. |
| Recombinant human factor VIIa (adjunctive agent) | 50 to 100 mcg/kg. It is preferable to start with a low dose (40 or 60 mcg/kg). The dose may be repeated once in 15 to 30 minutes if there is no response. Additional doses are unlikely to be effective. |
| Surgical interventions | |
| Repair lacerations | |
| Curettage | |
| Uterine compression suture (eg, B-Lynch suture) | |
| Uterine artery ligation | |
| Utero-ovarian artery ligation or cross clamp | |
| Pelvic packing | |
| Uterine tourniquet | |
| Focal myometrial excision | |
| Use of fibrin glues and patches to cover areas of oozing and promote clotting | |
| Placement of figure 8 sutures or other hemostatic sutures directly into the placental bed | |
| Resuscitative endovascular balloon occlusion of the aorta (REBOA) | |
| Internal iliac artery (hypogastric artery) ligation | |
| Aortic/iliac artery compression | |
| Hysterectomy, supracervical | |
| Hysterectomy, total | |
| Interventional endovascular procedures | |
| Selective arterial embolization | |
| Intermittent aortic balloon occlusion | |
| Common iliac artery balloon occlusion | |
| Blood bank | |
| Packed red blood cells | |
| Platelets | |
| Fresh frozen plasma | |
| Cryoprecipitate | |
| Nonsurgical interventions | |
| Uterine massage | |
| Intravenous fluids | |
| Intrauterine tamponade | |
| Intrauterine balloon or alternative device (eg, bladder catheter bulb, Sengstaken-Blakemore tube) | |
| Intrauterine vacuum | |
| Uterine packing (eg, 4-inch gauge packing) | |
| Consultations | |
| General surgery | |
| Trauma surgery | |
| Anesthesia team | |
| Interventional radiology | |
| Gynecologic oncology | |
| Urology | |
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