methergine

[jennifers]

So, I know methergine is contraindicated if a pts bp is high. But how high is too high? Do you have a protocol or a cut off? Just curious. I had a pt who had 130's over 90's. Made sure to tell the dr and he still prescribed...but also gave something for bp. What do you use instead for the first med if they have a high bp?

Just curious on different protocols.

[d2k2ross]

Typically, "130's/90's" wouldn't necessarily be considered hypertension. These readings are still partially within the "normal" range but are at the upper limits of "normal". Mild hypertension is defined as 140 to 159 and 90 to 94. So, depending on your diastolic reading exactly, your pt might not have hypertension at all.

[bagladyrn, RN]

I would question giving methergine with a diastolic in the 90's since it will send the bp higher. It does make sense that the doc ordered something for the bp at the same time.

Usually I see hemabate given instead of methergine in these cases. Be sure to ask the doctor for an order for Lomotil along with the hemabate though as one of the common side effects of hemabate is explosive diarrhea! I tell these patients "If you think you have to "pass gas" ask for a bedpan - it's not gas!

[jennifers]

Thanks for the tip on the lomotil! :) I thhink the hemabate is much more expensive so they try to use the methergine first right?

I'm still learning and appreciate the tips!

[klone, MSN, RN]

We almost never use hemabate. In fact, I think I've only given it once. Our docs prefer Cytotec and methergine - just as effective, fewer side effects.

[Jiayou]

I would question giving methergine with a diastolic in the 90's since it will send the bp higher. It does make sense that the doc ordered something for the bp at the same time.

Usually I see hemabate given instead of methergine in these cases. Be sure to ask the doctor for an order for Lomotil along with the hemabate though as one of the common side effects of hemabate is explosive diarrhea! I tell these patients "If you think you have to "pass gas" ask for a bedpan - it's not gas!

I agree with bagladyrn. In our hospital, we will give hemabate too instead of methergine. I don't know lomotil can be used for diarrhea. Thank you bagladyrn.

[catfac]

We very seldom use methergine. Hemabate is not used often. We use 60mg cytotec placed in the rectum. With good results. Of course fundal massage is also very important:idea:

[klone, MSN, RN]

We use 60mg cytotec placed in the rectum. With good results.

60 mg? Are you sure of that dosage? We use 800 micrograms rectally for PPH. 60 mg would be the equivalent of 60,000 micrograms (unless my math is off), which seems awfully high.

[catfac]

you are right I used the wrong abbreviation and a zero got dropped. I meant 600 mcg, So sorry I reviewed what I wrote and saw what I wanted and not what was there.

[redbeads]

Pitocin up to 50 units in IV (can be diluted in 1 or 2 bags of 1000ml LR or NS)

Cytotec 600-1000 mcg per rectum one time

Hemabate .25 mg IM q 15-90 minutes, not to exceed 8 doses (give lomotil), contraindicated in asthma and hypertension, or active renal, cardiac or hepatic disease

Methergine .2 mg IM q 10 minutes up to 2 doses, contraindicated in heart disease and hypertension

These are what we use at my hospital, in order of preference. I do believe that 130/90 is hypertension, but in each case, risks and benefits must be weighed and you did inform the doctor of her BP, just remember to chart that. :up:And, never forget to check for cervical lacerations if bleeding persists with a firm fundus.