Postpartum pit

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    Our hospital has recently started orders that say our ladies have to have a bag of pit running for several hours (I think it is 4) postpartum. Previously, the orders just read to medlock when current bag (at time of delivery) was finished unless the bleeding was heavy.

    Personally, I think it is overkill. The dose of pit is a reasonable one (that is, not a huge dose), but I just don't see it as necessary, especially for a uterus that may have already gotten hours and hours of pit. We have hemorrhages, but not enough IMO to justify pitting every single patient after she delivers. (And if they'd quit being so impatient with placentas we probably would have even fewer, but that's another thread.)

    Just wondering what you do. Is there some new national guideline or ACOG statement that I'm not aware of, or is it just us?
    Last edit by Elvish on Jul 25, '12

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  3. 25 Comments...

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    It's been a while since I've practiced in postpartum, but we always hung pit postpartum for the first 4 hours at least, longer if the patient was bleeding more heavily. It's better to be safe than sorry---even women who do not seem at first to heavily bleed can have that happen and I'd rather have at least pit on board so I can crank up the flow rate while I take other measures such as fundal massage/notify doc for other meds if needed. Postpartum hemorrage is a risk that is often easily alleviated by a simple drug infusion, such as pit, so why not.....
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    I do not work OB - but, I think it is painting with a pretty broad brush to assume that EVERY patient needs this type of intervention. Pit is not a benign medication.
    MamaEB, TexasCourgette, CrunchyMama, and 1 other like this.
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    Perhaps I could have worded my statement about a "simple drug infusion" a bit better. No, pitocin is not a benign drug. What I meant was that pit in 500-1000ml of fluid is a fairly simple IV to infuse. Yes, it requires monitoring, but really, for a pp patient 4 hours post delivery, her care is basically that of a PACU type patient and requires close monitoring, so that shouldn't be an issue. Sorry about the confusion. As to the use of pitocin postpartum, standards of practice still state that it is good for prophalaxis (spelling?) of post partum hemorrhage. Women at risk and seemingly not at risk for pp hemorrhage do benefit from the administration of pitocin. In answer to the OP's question about ACOG standards---it's been a standard for years, so I'm rather surprised that your hospital is just now getting around to making it a standard there......
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    Quote from kakamegamama
    In answer to the OP's question about ACOG standards---it's been a standard for years, so I'm rather surprised that your hospital is just now getting around to making it a standard there......
    It's standard to run in Pit immediately after delivery, in order to facilitate delivery of the placenta, but not for several hours afterward. Sometimes we'd leave the bag (if there was any hanging) running for a couple hours if the pt hadn't voided yet, or if her bleeding was heavy, but on every single person? No way. And we had hemorrhages, but not an excessive amount, and very few that just hanging a bag of Pit would've fixed.
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    Hmmm....interesting. I am curious----why is it an issue?
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    Quote from kakamegamama
    Hmmm....interesting. I am curious----why is it an issue?
    Are you asking why it's an issue for me, or why it would be a big deal to do this?
    Just curious, so I can answer appropriately.

    Do any other OB units do this?
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    Elvish---both. Thanks!
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    There are certain docs I work with who continue pit for at least 6 hours post partum. Other use cytotec in the rectum, or IM pitocin. I think that the use of medications should be based on symptoms and clinical presentation rather than what "could" happen. While it isn't a difficult thing to do (putting a bag on a pump) does the patient need to be treated with medication. I believe that if we really assessed our patients well and monitored bleeding, then the need for medication long term would be decreased. Unfortunately, acuity and the madness of having babies can sometimes keep us from doing that (reality bites). We created a "hemorrhage kit" that can be kept at the bedside during delivery (we actually have 2, one that is refrigerated and one that is not) that allows for ease of treatment instead of having to leave the room to get meds.

    I am not aware of any ACOG standard for pitocin administration post partum, at least with any timing attached to it. JCAHO has put PP hemorrhage on the watch list, but again, having to do more with ASSESSMENT and interventions based on those asssessments.
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    Babyktchr, that is kind of what I think too. It is certainly something to watch closely for, and even more closely when there are risk factors. We keep a PPH kit in each subsection of our floor as well. Most PP hemorrhages can be avoided by assessment and pretty simple interventions, without the need for IVF for several hours after a normal delivery.

    Kakamegamama, it's a problem for me personally because my philosophy tends to be to leave things alone until the need for intervention arises. I don't like to mess with Ma Nature's design unless it's necessary. This goes for pregnancy, labor, birth, and postpartum. So on a personal level it strikes me as unnecessary. From the patient's POV, having IV fluids interferes with mobility - getting up and down to the BR, taking care of baby, etc. Plus, the uterine contractions that pit causes can be painful. On a medical level, pit isn't a benign medication, as a PP has already said. There are definitely side effects, and if a uterus is already tired, it is not going to respond well to another 4-6 hours of pit.
    fromtheseaRN, LDRNMOMMY, and Adeleye like this.

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