Second-lineHemabate
Carboprost
Synthetic prostaglandin F2α analogue
Third-line uterotonic for refractory atonic PPH.
Deep IMIntramyometrial (off-label)
First-line for
- Atonic PPH unresponsive to oxytocin and ergometrine
Mechanism
PGF2α receptor agonism → strong sustained myometrial contraction. Also bronchoconstrictor.
“ABCD” — Carboprost cautions
- A — Asthma (absolute CI)
- B — Bronchospasm risk
- C — Cardiac disease
- D — Diarrhoea & fever very common
Dosing
- Dose
- 250 mcg deep IM, repeat q15 min (max 8 doses / 2 mg)
Contraindications
- AbsoluteAsthma
- AbsoluteActive cardiac, pulmonary, renal or hepatic disease
Side effects
- Diarrhoea, vomiting
- Fever, flushing
- Bronchospasm
- Hypertension
Fetal & maternal notes
- • Postpartum use only.
- • Brief lactation interruption typical.
Key interactions
Other oxytocics
OKAdditive — used sequentially in PPH algorithm
Clinical pearls
- 💡 Always give loperamide/antiemetic cover.
- 💡 If 3 doses ineffective → escalate to surgical/IR management.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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