ALSO Advanced Life Support in Obstetrics mnemonics

0.2 mg IM every 2-4 hours Vocalize no HTN or pre-eclampsia

Methergine (Methylergonovine)

1000 mcg per rectum

Cytotec (Misoprostol, Prostaglandin E1)

0.25 mg IM every 15-90 minutes (max 2mg or 8 doses) Vocalize no pulmonary concerns (Asthma, etc.) AEs: diarrhea, vomitting

Hemabate (Prostaglandin F2 alpha)

Pulse, Pressure, Access (2 large IV), Blood (counts, clotting, crossmatch 4-6 units), Fluids, Drugs

PPH Arms PPABFD

Airway, Breathing, O2, Flat, Recorder

PPH Head ABOFR

Assign Head, Assign Arms, Bladder, Bimanual, 4Ts, continue drugs -> Surgery

PPH Uterus HABB T4 - Surgery

PPH: 10-20 IU IM or 10-40 IU/L IV (500cc over 10 then 250/hr)

Pitocin (Oxytocin)

Evaluate for episiotomy

Shoulder Dystocia E (first E)

Enter rotational maneuvers

Shoulder Dystocia E (second E)

Help, call for it

Shoulder Dystocia H

Legs, put them in McRoberts

Shoulder Dystocia L

Pressure, suprabpubic

Shoulder Dystocia P

Remove posterior arm

Shoulder Dystocia R (first R)

Roll patient to Gaskin position

Shoulder Dystocia R (second R)

Address the Pt, Ask for help, Anesthesia adequate

Vacuum A (3)

Bladder empty

Vacuum B

Cervix dilated completely (and membranes ruptured)

Vacuum C

Determine position of head. Voice Shoulder Dystocia possibility. Review HELPERR

Vacuum D (2)

Equipment check and ready

Vacuum E

Flexion point placement. Feel for maternal tissue

Vacuum F (2)

Gentle traction following pelvic curve, rising as head crowns

Vacuum G

Halt if: 1) 3 pop offs 2) 3 pulls/pushes without progress 3) 20 minutes of use

Vacuum H (3)

Incision: Evaluate for episiotomy

Vacuum I

Jaw: remove cup when jaw is reachable

Vacuum J