What is the recommended time to administer Ergot (ergometrine) 250mcg and Hemabate (carboprost tromethamine) 250mcg after delivery in a postpartum patient?

Timing of Ergometrine and Hemabate Administration After Delivery

Both ergometrine 250mcg and Hemabate (carboprost) 250mcg should be administered immediately after delivery of the baby or placenta as part of active management of the third stage of labor to prevent postpartum hemorrhage.

Active Management Protocol

Ergometrine (Ergot) 250mcg:

• Administer intramuscularly immediately after delivery of the anterior shoulder or within 1 minute of delivery of the baby 1
• Can be given safely either with delivery of the baby or after delivery of the placenta 1
• Often combined with oxytocin as part of standard prophylaxis 2

Hemabate (Carboprost) 250mcg:

• Inject directly into the uterine muscle (intramyometrial) immediately after placental delivery during cesarean section 3
• For vaginal delivery, can be administered intramuscularly in the immediate postpartum period 4
• Most effective when given as first-line prevention in high-risk patients (twin pregnancy, polyhydramnios, fetal macrosomia, placenta previa) 3

Clinical Context and Timing Considerations

Standard prophylaxis timing:

• Oxytocin remains the first-line uterotonic and should be given with delivery of the baby (10 units IM or 20 units IV diluted in 500mL saline) 1
• Ergometrine is typically reserved for combination therapy or when oxytocin alone is insufficient 2
• Hemabate is particularly valuable in high-risk scenarios and can be administered prophylactically at the time of delivery rather than waiting for hemorrhage to develop 3

Treatment timing if hemorrhage occurs:

• If postpartum hemorrhage develops despite initial oxytocin, additional uterotonics should be administered within 30 minutes of PPH diagnosis 5
• Hemabate demonstrates 87.8% success rate in controlling refractory atonic hemorrhage when given promptly 4

Important Clinical Caveats

Contraindications to consider:

• Ergometrine should be avoided in patients with hypertension or preeclampsia due to vasoconstrictive effects 2
• Both medications can cause side effects including nausea and vomiting (11.5% incidence with Hemabate), though these typically resolve without treatment 3
• The combination of oxytocin plus Hemabate significantly reduces bleeding compared to oxytocin alone (332ml vs 445ml during cesarean section) 3

Route-specific recommendations:

• During cesarean section: inject Hemabate directly into uterine muscle for maximum efficacy 3
• For vaginal delivery: intramuscular administration is appropriate for both agents 1, 2