DEPARTMENT OF HEALTH

1. (Methergine) Postpartum

   hemorrhage only

   0.2mg

   Intramuscular

   or orally

   Single dose. Every six hours, may repeat

   3 times. Contraindicated in hypertension and Raynaud's Disease.

   Lidocaine HCL

   1% or 2%

   Local anesthetic for use during postpartum repair

   of lacerations or episiotomy

   Maximum 50 ml (1%)

   Maximum 15 ml (2%)

   Precutaneous infiltration only

   Completion of repair

   Penicillin G

2. (Recommended) Group B Strep

   Prophylaxis

   5 million units initial dose, then 2.5 million units every 4 hours until birth

   IV in > 100 ml LR, NS or

   D₅LR

   Until birth of baby

   Ampicillin

   Sodium

3. (Alternative) Group B Strep

   Prophylaxis

   2 grams initial dose, then 1 gram every 4 hours until birth

   IV in > 100ml NS

   Until birth of baby

   Cefazolin Sodium

   Group B Strep

   Prophylaxis

   2 grams initial dose, then 1 gram every 8 hours

   IV in > 100 ml LR, NS or

   D₅LR

   Until birth of baby

   Clindamycin

   Phosphate

   Group B Strep Prophylaxis

   900 mg every 8 hours

   IV in > 100 ml

   NS or LR

   Until birth of baby

   Lactated Ringers

4. (LR) To administer group B Strep Prophylaxis

   Intravenous catheter

   5% Dextrose in

   Lactated Ringer's

   solution (D₅LR)

   To administer

   group B Strep

   Prophylaxis

   Intravenous

   catheter

   0.9% Sodium

   Chloride (NS)

   To administer group B Strep Prophylaxis

   Intravenous catheter

   Oxygen

   Maternal/Fetal Distress, or Neonatal Resuscitation

   10-12 L/min

   10 L/min

   Mask or bag and mask

   Until stabilization is achieved or transfer to a hospital is complete

   0.5%

   Erythromycin Ophthalmic Ointment

   Prophylaxis of Neonatal Opthalmia

   1 cm ribbon in each eye

   Topical

   1 dose

   Rh(D) Immune Globulin

   Prevention of RH(D) sensitization in Rh(D) negative women

   300 mcg

   Intramuscularly

   Single dose at any gestation for Rh(D) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma.

   Single dose at 26-28 weeks gestation for Rh(D) negative, antibody negative women.

   Single dose for Rh(D) negative, antibody negative women within 72 hours of delivery of Rh(D) positive infant, or infant with unknown blood type.

   Tranexamic Acid (TXA)

   Postpartum Hemorrhage

   To be used when initial anti-hemorrhagic therapies fail and with notification of local medical support

   100 mg/ml (1g)

   IV at 1 ml per minute

   2nd dose if bleeding continues past 30 min or restarts within 24 hours

   IV Fluids

   ·Lactate Ringers (LR)

   ·.45% Saline

   ·.9% Normal Saline

   Postpartum Hemorrhage

   Infuse 1 liter at wide-open rate

   IV line with 16-18 gauge needle

   After first liter, a second liter may be titrated to client's condition. With the start of the second liter, transport to hospital is required and local medical support will be notified.

CERTIFIED PROFESSIONAL MIDWIVES

DRUG FORMULARY

Chapter 20:86:03

APPENDIX A

SEE: 20:86:03:11

‎

Drug

Indication

Dose

Route of Administration

Duration of Treatment

Phylloquinone

(Vitamin K₁)

Prophylaxis for Vitamin K

deficiency

bleeding

1 mg

Intramuscularly

1 dose

Oxytocin (Pitocin)

Postpartum

hemorrhage only

10 units/ml

Intramuscularly

only

1-2 doses. Transport to

hospital required if more

than two (2) doses are

administered.

Misoprostol

Note: This is an appropriate off label use of this drug.

Postpartum

hemorrhage only

200 microgram

tabs, at 800

micrograms per

dose (4tabs)

Rectal or

sublingual, or

may be used as

½ rectally and

½ sublingually

1-2 doses. Transport to

hospital required if more than

2 doses are administered. Not to exceed 800 micrograms.

Methylergonovine

Source: 45 SDR 31, effective September 10, 2018 ; 48 SDR 115, effective May 23, 2022 .

Prior versions effective: 2018-09-10.