1st line
- ›Oxytocin 5 units slow IV, then 40 units in 500 mL Hartmann's over 4 h.
2nd line
- ›Ergometrine 500 mcg IM/slow IV (AVOID if HTN, pre-eclampsia, cardiac disease).
3rd line
- ›Carboprost (Hemabate) 250 mcg IM every 15 min (max 8 doses). AVOID in asthma.
Adjuncts
- ›Tranexamic acid 1 g IV within 3 h of PPH (WOMAN trial).
- ›Misoprostol 800 mcg rectal/sublingual if no other options.
Common mistakes
- •Ergometrine in hypertension → hypertensive crisis, stroke.
- •Carboprost in asthma → bronchospasm.
- •Delaying TXA beyond 3 h — reduced benefit after that window.