IM: 500 micrograms of ergometrine and 5 units of oxytocin in 1ml

-A known hypersensitivity to sodium lactate

-Congestive heart failure or severe impairment of renal function

-Clinical states in which the administration of sodium and chloride is detrimental

-DKA coma and pre coma

-Neonates

Sudden drop in systolic blood pressure.

Replacement of fluid to maintain circulatory volume until blood is

available as per local guidelines for postpartum haemorrhage.

due to arterial constriction and the increase of vascular resistance, it is able to rehydrate the body and help prevent shock. This is because is reduces hypotension and allows the body to stop compensating, so BP can decrease as well as the RR.

-Initial dose: 250ml

-Max dose: 1l

Onset of action 7-10 minutes

In labour, prior to the birth of the baby

Severe cardiac, liver or kidney disease-

Hypertension and severe pre-eclampsia-

Possible multiple pregnancy/known or suspected fetus in utero.

-       If bleeding is not arrested, consider possibility of retained placental fragment, or soft tissue injury (cervical or vaginal laceration), or clotting defect and take appropriate measures.

-       Vasoconstriction and rarely acute pulmonary oedema.

-       Mild or moderate hypertension, cardiac, liver or kidney disease (contra-indications if severe) – women with coronary artery disease may be more susceptible to angina or myocardial infarction.

-       History of QT prolongation syndrome (see medicine interactions).

-       Acute porphyria.

-       Multiple pregnancy – should not be given until after delivery of the last baby. 

-       Raynaud’s disease.

The vaginal route is not appropriate in post-partum haemorrhage or for miscarriage, but the rectal route may be considered when appropriate (e.g. impaired consciousness).

Dose - 800mcg (4x200mcg tablets)

No repeat dose.

Concentration 200mcg per tablet.

Max dose 800mcg.

Misoprostol is not recommended for administration to patients aged 11 or under.

-       Abdominal pain

-       Headache

-       Hypertension and bradycardia

-       Chest pain and rarely anaphylactic reactions

Must be stored in a fridge at a temperature 2-8 degrees and once removed must be stored in a dark place, for no longer than two months.

Ergonovine directly stimulates the uterine muscle to increase force and frequency of contractions. With usual doses, these contractions precede periods of relaxation; with larger doses, basal uterine tone is elevated and these relaxation periods will be decreased. Contraction of the uterine wall around bleeding vessels at the placental site produces hemostasis. Ergonovine also induces cervical contractions. The sensitivity of the uterus to the oxytocic effect is much greater toward the end of pregnancy. The oxytocic actions of ergonovine are greater than its vascular effects. Ergonovine, like other ergot alkaloids, produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release. It is a less potent vasoconstrictor than ergotamine. As a diagnostic aid (coronary vasospasm), ergonovine causes vasoconstriction of coronary arteries.

(Hartmann’s) is used to replace

body fluid and mineral salts that

may be lost for a variety of medical

reasons. It is especially suitable

when the losses result in too much

acid being present in the blood.

Uterotonic meaning to strengthen contractions in pregnant women. Oxytocin activates sensory nerves during labour.

Ergometrine increases the amplitude and frequency of uterine contraction and uterine tone which in turn impedes uterine blood flow. The contraction of the uterine wall produces haemostasis.

D - 100% bioavailability as given IV

M - salt is taken into GI tract, remaining unabsorbed as the liquid contents pass through stomach and small bowel. Then passes through the colon where salt is taken into the blood.

E - Excess excreted by kidneys

·         Used for the management of the last stage of labour aka third stage, for the delivery of placenta.

·         Also the prevention and control of bleeding post-delivery.

·         It causes the uterus to contract. It stimulates the womb to contract which helps the placenta to separate from the womb which reduces the risk of heavy bleeding.

·         It can be given after the placenta is given purely to prevent or control heavy bleeding.

In labour, prior to the birth of the baby (with a multiple pregnancy, ensure all babies have delivered).Known hypersensitivity to

misoprostol.

Secondary post-partum haemorrhage (excess bleeding more than 24 hours after delivery of the baby).

D - sublingual with 10 mins to effect. Bioavailability as is extensively absorbed. Highly protein bound

M - 1st pass metabolism in liver with half life of 20-40 mind

E - Expelled in urine.