Postpartum pit

[Elvish]

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?

[sweetgeorgia]

Totally agree with you. They are over medicating, even though it may be necessary for specific patients. Maybe they need to come up with a scale to determine the risk level of each patient individually and then prescribe following that protocol?

[keasc20]

We do 2 bags of pit postpartum. If they can void a large amount, I will saline lock them after they are up and stable.

[kakamegamama]

Interesting discussion, and lots to think about.......

[serenity1]

We run pit wide open at delivery of placenta and hang one more bag (30/500) of pitocin at 150 ml per hour until empty as standard policy. We do have one particular doc that runs the second bag at 62 ml per hour until empty. He bases this on a study that he says shows it is not the amount of pitocin given, but the length of time that prevents pph. I do not know what study he is referring to.

[CEG]

Our hospital tends to run in whatever is left in the ubiquitous labor augmentation bag and one more bag. I am a CNM and most of my patients decline routine pitocin :) I recommend it in the case of risk factors, but since most of my patients avoid other interventions as well, their risk for hemorrhage is lower.

[Traveldee]

At the facility I work in, we either give 10 units pitocin IM after delivery, or infuse 20 units pitocin in 1000 ml LR IV (or, if she was receiving pitocin for induction or augmentation and the medication is hanging, we normally will use what's left of that unless the physician request otherwise.) Then, if bleeding is excessive despite this pitocin and fundal massage, emptying her bladder, etc., the doctor might order cytotec rectally or methergine IM, perhaps a second bag of pit to hang after the first infuses...anyways that's one hospital's way of doing things...I am curious why the change in your hospital's policy? Did they say if it was evidence based?

[LibraSunCNM, BSN, MSN, CNM]

Oh my lord, do not get me started on nonsensical postpartum pit orders. I work Mother/Baby in a large, metropolitan teaching hospital that is Magnet (I am also studying to become a CNM). When I transferred to M/B after starting in med/surg, I was so confused as to why every single lady partsl delivery got 2 1-liter bags of LR each with 20 units of pit, and why c-sections get 3 bags. I asked everyone for the rationale, searched online for evidence supporting this practice, and got nada.

We also, not so coincidentally in my opinion, have a high rate of OB hemorrhage. This fact has sparked the creation of a hemorrhage cart next to the crash cart, a hemorrhage education fair for the nurses, and JUST now, the promise that the current practice of 40-60 units of postpartum pit was being "looked into." It is so ridiculous and unnecessary, not least because as klone pointed out, it is a pain for moms who want to breastfeed and are lugging around an IV pole when otherwise totally fine. I also have found studies linking maternal pit with newborn jaundice, which needs more attention as well.

In short, Elvish, I feel your pain!

[eden]

We do either 5 units IV or 10 units IM, that's it. We only hang a bag if mom is having significant bleeding after that small dose. Hanging a bag on everyone really seems overkill to me. With what we give we certainly don't have a large number of PPH's and we have never had a woman who initally refused pit continue to refuse if she is losing too much blood.

[HeartsOpenWide, RN]

We only give Pitocin if needed. I think it is a cultural thing (The culture of the OBs practicing in that hospital I mean). At my previous job they all turned the Pitocin wide open (40 units).

Also at my hospital, they usually do Pitocin to first Liter of fluid post op C/S; but we had a new doc who never performed at our hospital before (normally works at a different hospital) and he had Pitocin 20units running @125 for 12hrs post-op.

[JStitt01L&D]

I work LDRP and if a patient already has pit hanging then we just bolus in the remainder of the bag ( 30 units in 500ml ). If she did not have pit hanging already we either give 10 units IM or bolus the 30 units depending on physician preference. We have had patients refuse the pitocin and the physicians rarely have a problem with that as long as they know the risks and that if heavy bleeding occurs they will get pitocin.

[FLOBRN]

I was a bit surprised at the person saying you give pit IV push... please read the following article. In addition the FDA recommends it only as IM or as an infusion - not IV push.

http://meds.queensu.ca/medicine/obgyn/pdf/Hemodynamics_after_oxytocin.pdf

[Fyreflie]

I was a bit surprised at the person saying you give pit IV push... please read the following article. In addition the FDA recommends it only as IM or as an infusion - not IV push.

http://meds.queensu.ca/medicine/obgyn/pdf/Hemodynamics_after_oxytocin.pdf

I'm assuming you mean as third stage management? Here in Canada the standard is 5 units IV push at the anterior shoulder prior to the placenta (10 units IM if Mom has no IV) and then the infusion varies by doctor and facility. I've never heard that the 5 units at the shoulder can cause hypotension but we never give IV push after the baby is born.