midwives-what's your limit on Pit?

[mothercat]

This came up in a discussion over the weekend. I am asking only about postpartum/ after the baby has been born.

Do you give Pit IM before the placenta is out? Under what circumstances?

How many doses of Pit will you give before you decide a transport is necessary?

Probably most important, how did you develop these guidelines?

[Jane]

In general (what's general), I'd give two IM doses before starting an IV with 20 units in 500-1000 cc fluid.
I think about Pit after no placenta after 20 minutes.
Transport depends on the situation stability. After giving pit IV, I want to see normal bleeding after d/c the bag. If not, transfer. I don't like to give Methergine b/c of how long it takes to wear off - you can have a false sense of the uterus effectiveness at stopping bleeding b/c you have 4 hours of "help".

[mwherbs]

doesn't matter before or after the placenta is out
on very rare occasions I have given pit in the shoulder with the birth of the shoulder- in particular a woman who is 100 miles from the nearest hospital and who has had a past history of brisk,severe hemorrhages- all over 1500 loss and symptomatic-- placenta was on the heels of the baby and she has only about a 500 loss with that birth- it takes a bit of time for pit to work it isn't instant.

2 shots - 20 units
first bag of IV fluid maybe another 20 or maybe just IV fluids because depending on the bleed I may want to push the fluid---and leave with mom all hooked up I have had hospitals maintain the IV we have set up- other times they put something in another place

methergin yep but someone I am giving methergin to I will be there after 4 hrs and if the bleeding picks up again (which I have only seen once) another dose

what do I have? partial retained placenta- we are out the door asap I will remove inroute but no playing around at home- or not much , it is not so much about time as briskness of bleed and amount of loss-- after the placenta is out methergin I am very happy with and consider it a blessing
if you have marginal BP women they tend to pour blood- consider IV first fast-
I never just rely on a drug or herbs or just hand skills but a combo
---
there are several other things to do cath , rule out cervical tear or some other bleeder.... what does the uterus feel like? do we have a uterine infection??

[mothercat]

Thank you for the answers so far. That's pretty much in line with what I do.

So, here's the part two question:
If you knew you had a hospital that did OB within a couple of miles would you give multiple doses of Pit (more than 2) to try to deliver a retained placenta?

If you have done a manual removal, what, if anything, do you give for prophylaxis for infection?

[momileigh]

I didn't realize that pit with the del. of the shoulder was effective. I was taught to use syntometrine (homemade) as you describe. Good to know.