Pitocin to control bleeding of laceration

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I was asked to open pitocin up on a precipitous delivery by a fellow RN prior to the delivery of the placenta. I was always taught to apply pressure to the laceration but that the pitocin shouldnt be given until the placenta is delivered. The doctor arrived and the pt. bleeding slowed down (total ebl was 400ml). Does anyone have any experience in this area? Is there a reference that would contain this info? Any help would be appreciated.

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In Canada the norm is to give pitocin with the delivery of the shoulders, not wait until the placenta is delivered.

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Specializes in L & D; Postpartum.

The pitocin won't control bleeding from a laceration. It would be given in case the uterus doesn't clamp down after delivery of the placenta and doesn't respond to massage or the baby at the breast.

Most times you don't want to give it until the placenta delivers because it can cause clamping to occur before the placenta separates. However, in the good old days, we had a doc who had us give a minim IM with the delivery of the baby's head. And more after the placenta came.

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Our OB's want the pit wide open immediately after delivery of the baby, but to help the uterus contract, not stop laceration bleeding.

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Specializes in Behavioral Health.

We open the pit after placenta delivery....

Never heard of it for lac bleeding.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It will NOT stop lac bleeding, make no mistake. The only thing that can stop the bleeding from a laceration is direct pressure to the site, if you can apply it----and REPAIR. I have learned this the hard way----long story if you want to hear it sometime, just ask.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
It will NOT stop lac bleeding, make no mistake. The only thing that can stop the bleeding from a laceration is direct pressure to the site, if you can apply it----and REPAIR. I have learned this the hard way----long story if you want to hear it sometime, just ask.

:yeahthat:

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I wanna hear the story!

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long story if you want to hear it sometime, just ask.

Don't leave us hanging Deb! Please share :)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

OK...

Why is it, we all learn our most valuable and dangerous lessons in our first post-grad year? I know I surely did....

Had a girl was about 35 weeks' who had a bad prenatal health history to begin with. Smoker, PIH'er , poorly-fed....etc etc etc. Anyhow, she had a complicated and difficult lady partsl delivery w/a pretty hefty lac (want to say, 3rd degree----but that was not the problem, really).

Her infant was put in our SCN for observation, ABX, O2 therapy, etc. He was struggling enough. Lil guy was a real scrapper, and so tiny.

Meantime, mom, who is not particulary healthy to begin with, is recovering from her delivery herself, really wanting to see her baby. Dr approved her being wheeled in a chair to see him, so we did. She was a tiny lil thing, weighing nearly 98 lb soaking wet, I think. I still see her face today, nearly 8 years later. Took her in to the nursery to see her boy "Luke" ---yep I remember his name---- and she was stable at the time. It was probably 2 or 3 hours' out from delivery, can't be sure. Late at night, that I remember.

Anyhow, she was sitting there, holding her newborn's hand, when she began to feel "yucky" (her words). She was nauseated and dizzy. She was pale, mottled and looking really bad. Wheeled her back in her room asap, and put her on bed. In the chair, in the chux, there was a HUGE pool of blood, filling the whole chair, and spilling onto the floor like water once she was taken out of it. The sound sticks in my ears to this day......it was like water from a tap.

On the bed, I felt for her fundus ---easy to find as she was so skinny. I am thinking, "I DO NOT GET IT!" It's firm and 2 fingers below u. Yet she is POURING BLOOD, i MEAN POURING. Open her pitocin wide, give her hemabate, all of it. Her b/p was about 75/38 at this point, heart rate in 120s....yea she is getting shocky and actually begging us not to let her die (yea I am getting goose pimples here).

Nothing we could do, massage, pit, hemabate, 2 IV's open wide, was doing it. I check her peri. It's intact. WHAT THE HECK IS GOING ON???! My mind is screaming, what is wrong w/my patient?

So I have house supe page dr and tell her get him here YESTERDAY, this patient is still bleeding like mad-----just pooling dark red blood across her chux. And showing increasing signs of shock...

Dr comes in, checks her out and has her taken back to OR for a check "inside".

What did they find? A TEENY TINY cervical lacertion--------so small, they nearly could not see it til they got the blood out of the way.

THIS was the cause of all this misery, the patient going into shock, bleeding dang near to death? NO WAY.

Yea, way. I learned the very HARD WAY that I can't trust the "usual suspects":

uterus----I wasted time, it was NOT boggy to begin with. I wasted time giving her mass doses of pitocin and hemabate to stop bleeding that would not respond in the first place.

perineal lac-----it was CLEAN and INTACT. Not the problem either----

It was her CERVIX, something I could not see, something I could not treat. More experience would have had me calling her dr sooner and knowing all my interventions were not only a waste of time, but potentially dangerous (remember, PIH'er---last thing she needed was the antidiuretic effect of mass doses of IV pitocin).

Well, once repaired and having received 3 units of blood, she did fine. She recovered to take her baby home 8 days later. She even wrote a letter to our hospital CEO about the "nurses who saved her life that night". I felt awful. I did not save anyone; I could have COST her life not knowing what to do in the first place. Plus, the dark red nature of her blood should have been a clue.....ah hindsight.

But I learned. Learned to see beyond the obvious and act appropriately.

Hope this story helps you understand why I feel so strongly about lacerations and pitocin. NEVER take "pit" lightly, even post-partum. It can cause complications of fluid volumes excess/intoxication if you are not careful. It will NOT treat non-uterine bleeding.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have a few other "first year" learning experiences I will never forget either---we ought to start a thread---as long as we are discreet in telling them.....Let us just say, working in a rural county hospital, caring for very high risk people whom we could not just "ship" (nearest Level 3 hospital was 140 mi away)---- in that first year after school----taught me a WHOLE lot. I look back and shudder.

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OK...

Why is it, we all learn our most valuable and dangerous lessons in our first post-grad year? I know I surely did....

Had a girl was about 35 weeks' who had a bad prenatal health history to begin with. Smoker, PIH'er , poorly-fed....etc etc etc. Anyhow, she had a complicated and difficult lady partsl delivery w/a pretty hefty lac (want to say, 3rd degree----but that was not the problem, really).

Her infant was put in our SCN for observation, ABX, O2 therapy, etc. He was struggling enough. Lil guy was a real scrapper, and so tiny.

Meantime, mom, who is not particulary healthy to begin with, is recovering from her delivery herself, really wanting to see her baby. Dr approved her being wheeled in a chair to see him, so we did. She was a tiny lil thing, weighing nearly 98 lb soaking wet, I think. I still see her face today, nearly 8 years later. Took her in to the nursery to see her boy "Luke" ---yep I remember his name---- and she was stable at the time. It was probably 2 or 3 hours' out from delivery, can't be sure. Late at night, that I remember.

Anyhow, she was sitting there, holding her newborn's hand, when she began to feel "yucky" (her words). She was nauseated and dizzy. She was pale, mottled and looking really bad. Wheeled her back in her room asap, and put her on bed. In the chair, in the chux, there was a HUGE pool of blood, filling the whole chair, and spilling onto the floor like water once she was taken out of it. The sound sticks in my ears to this day......it was like water from a tap.

On the bed, I felt for her fundus ---easy to find as she was so skinny. I am thinking, "I DO NOT GET IT!" It's firm and 2 fingers below u. Yet she is POURING BLOOD, i MEAN POURING. Open her pitocin wide, give her hemabate, all of it. Her b/p was about 75/38 at this point, heart rate in 120s....yea she is getting shocky and actually begging us not to let her die (yea I am getting goose pimples here).

Nothing we could do, massage, pit, hemabate, 2 IV's open wide, was doing it. I check her peri. It's intact. WHAT THE HECK IS GOING ON???! My mind is screaming, what is wrong w/my patient?

So I have house supe page dr and tell her get him here YESTERDAY, this patient is still bleeding like mad-----just pooling dark red blood across her chux. And showing increasing signs of shock...

Dr comes in, checks her out and has her taken back to OR for a check "inside".

What did they find? A TEENY TINY cervical lacertion--------so small, they nearly could not see it til they got the blood out of the way.

THIS was the cause of all this misery, the patient going into shock, bleeding dang near to death? NO WAY.

Yea, way. I learned the very HARD WAY that I can't trust the "usual suspects":

uterus----I wasted time, it was NOT boggy to begin with. I wasted time giving her mass doses of pitocin and hemabate to stop bleeding that would not respond in the first place.

perineal lac-----it was CLEAN and INTACT. Not the problem either----

It was her CERVIX, something I could not see, something I could not treat. More experience would have had me calling her dr sooner and knowing all my interventions were not only a waste of time, but potentially dangerous (remember, PIH'er---last thing she needed was the antidiuretic effect of mass doses of IV pitocin).

Well, once repaired and having received 3 units of blood, she did fine. She recovered to take her baby home 8 days later. She even wrote a letter to our hospital CEO about the "nurses who saved her life that night". I felt awful. I did not save anyone; I could have COST her life not knowing what to do in the first place. Plus, the dark red nature of her blood should have been a clue.....ah hindsight.

But I learned. Learned to see beyond the obvious and act appropriately.

Hope this story helps you understand why I feel so strongly about lacerations and pitocin. NEVER take "pit" lightly, even post-partum. It can cause complications of fluid volumes excess/intoxication if you are not careful. It will NOT treat non-uterine bleeding.

Thanks for sharing your story. Scary stuff...

I knew there was a reason I kept asking them to cut the cerclage before my cervix tore...

Shannon

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