Understanding What Medications Are Used to Stop Postpartum Bleeding

October 12, 2025 •

3 min read

Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death, affecting up to 10% of deliveries. A critical part of emergency obstetrical care involves understanding what medications are used to stop postpartum bleeding, with different drugs targeting various underlying causes of hemorrhage.

Quick Summary

This article outlines the standard medical interventions for controlling postpartum hemorrhage. It covers the first-line uterotonic agent, oxytocin, and secondary medications like methylergonovine, carboprost, and misoprostol. It also explains the role of the adjunctive therapy, tranexamic acid.

Key Points

First-Line Therapy is Oxytocin: Oxytocin is the primary medication used to stimulate uterine contractions and stop postpartum bleeding.
Secondary Medications Vary by Patient: If oxytocin fails, second-line uterotonics like methylergonovine, carboprost, and misoprostol are used, with the choice depending on patient-specific contraindications.
Tranexamic Acid is an Adjunctive Agent: This antifibrinolytic drug helps stabilize blood clots and is most effective when administered within three hours of bleeding onset, supplementing the action of uterotonics.
Know the Contraindications: Certain medications are not safe for all patients; for instance, methylergonovine is avoided in those with hypertension, while carboprost is avoided in patients with asthma.
Timeliness is Critical: Delaying treatment, particularly for administering oxytocin or tranexamic acid, is associated with more severe PPH and worse outcomes.
Not All Medications Cause Contractions: Unlike uterotonics, tranexamic acid works by stabilizing existing blood clots, providing a different but crucial mechanism for hemorrhage control.

Postpartum hemorrhage (PPH) is defined as a cumulative blood loss of 1,000 mL or more, or any blood loss causing hemodynamic instability, within 24 hours of delivery. The most common cause of PPH is uterine atony, a condition where the uterus fails to contract sufficiently after childbirth to compress the blood vessels that supplied the placenta. The medications used to manage PPH are primarily uterotonics, which stimulate uterine contractions, and antifibrinolytic agents, which promote blood clotting.

First-Line Medication: Oxytocin (Pitocin)

Oxytocin is the gold-standard and most widely used first-line medication for both preventing and treating PPH. It is a hormone that stimulates the upper myometrium (the muscular layer of the uterus) to contract rhythmically. These contractions constrict the spiral arteries within the uterus, reducing blood flow to the area where the placenta was attached and facilitating the arrest of bleeding.

Administration: Oxytocin is typically administered intravenously or intramuscularly.
Benefits: Fast-acting, with a generally favorable side-effect profile compared to other uterotonics. It is effective even if already used for labor induction.
Considerations: Can cause hypotension, especially with rapid IV administration. Prolonged infusions or high doses may lead to water intoxication due to its antidiuretic effect.

Second-Line Medications

If oxytocin fails to control the bleeding, clinicians turn to other uterotonic agents. The choice often depends on the patient's specific health conditions, as some have significant contraindications.

Methylergonovine (Methergine)

Methylergonovine is an ergot alkaloid that causes a strong, sustained uterine contraction (tetanic contraction). It is administered intramuscularly. Common side effects include nausea, vomiting, and increased blood pressure. Due to its effect on blood pressure, it is contraindicated in patients with hypertensive disorders.

Carboprost Tromethamine (Hemabate)

Carboprost is a synthetic prostaglandin analogue that improves uterine contractility and causes vasoconstriction. It is typically administered intramuscularly or directly into the myometrium. Side effects include nausea, vomiting, diarrhea, and fever. It should be avoided in patients with asthma due to the risk of bronchoconstriction.

Misoprostol (Cytotec)

Misoprostol is a prostaglandin E1 analogue that can be particularly useful in low-resource settings due to its heat stability and ease of administration. It is typically administered rectally or sublingually for treatment. Side effects can include shivering, fever, nausea, and diarrhea. While effective, it is often used when oxytocin is not available or has not been effective.

Adjunctive Therapy: Tranexamic Acid (Cyklokapron)

Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the breakdown of blood clots, thereby stabilizing them and reducing bleeding. It is administered intravenously over a period of time, ideally within three hours of birth. A second dose may be given if bleeding continues. Studies have shown that TXA significantly reduces death due to bleeding when given early, with no increase in the risk of thromboembolic events. Unlike uterotonics, TXA focuses on supporting the body's natural clotting process.

Choosing the Right Medication: A Comparison


Medication	Mechanism of Action	Common Routes	Side Effects	Key Contraindications
Oxytocin	Stimulates rhythmic uterine contractions to constrict blood vessels.	Intravenous (IV), Intramuscular (IM)	Nausea, vomiting, hypotension	Hypersensitivity
Methylergonovine	Causes sustained uterine contraction.	Intramuscular (IM)	Increased blood pressure, nausea, vomiting	Hypertensive disorders (pre-eclampsia)
Carboprost	Improves uterine contractility and causes vasoconstriction.	Intramuscular (IM), Intramyometrial	Nausea, vomiting, diarrhea, fever	Asthma, cardiovascular disease
Misoprostol	Causes generalized smooth muscle contraction.	Rectal, Sublingual, Oral	Shivering, fever, nausea, diarrhea	Caution with cardiovascular disease
Tranexamic Acid	Inhibits the breakdown of blood clots.	Intravenous (IV)	Nausea, diarrhea, visual disturbances	Thromboembolic events, renal impairment

The PPH Management Algorithm

In a clinical setting, healthcare providers follow a systematic approach to manage PPH. After a diagnosis is made, the initial response includes fundal massage and the administration of oxytocin. If bleeding persists, a secondary uterotonic is selected based on patient factors, such as avoiding methylergonovine in hypertensive patients. Tranexamic acid is added for severe cases or when uterotonics are insufficient, ideally within three hours of birth. Non-pharmacological interventions may also be used in refractory cases.

Conclusion

Managing postpartum hemorrhage requires a rapid and coordinated response, with medication as a cornerstone. Oxytocin is the first-line therapy, but alternative uterotonics and adjunctive agents like tranexamic acid are crucial for severe or persistent bleeding. Medication choice is tailored to the patient, emphasizing the need to understand each drug's mechanism, side effects, and contraindications. Swift administration, often guided by protocols, is vital for improving maternal outcomes and saving lives.

Frequently Asked Questions

The first medication given for postpartum bleeding is typically oxytocin. It is a uterotonic agent that stimulates the uterus to contract, which helps to close off the blood vessels that supplied the placenta.

Uterine atony is the most common cause of postpartum bleeding and occurs when the uterus fails to contract effectively after childbirth. Medications called uterotonics, such as oxytocin and carboprost, are used to treat it by forcing the uterus to contract and compress the bleeding vessels.

Tranexamic acid (TXA) is an antifibrinolytic agent that works by preventing the breakdown of blood clots, helping to stabilize them. Unlike uterotonics, it does not cause uterine contractions but rather supports the body's natural clotting mechanisms.

Yes, contraindications exist. For example, methylergonovine is avoided in patients with high blood pressure, while carboprost is generally not given to patients with asthma. Clinicians must choose medications based on a patient's specific health history.

Yes, misoprostol is a prostaglandin that can be used as an alternative to oxytocin, especially in low-resource settings where oxytocin may not be available or requires special storage.

Side effects vary by medication. Oxytocin can cause nausea and hypotension, methylergonovine can increase blood pressure, carboprost often causes nausea and diarrhea, and misoprostol may cause shivering and fever.

For maximum effectiveness in reducing maternal death from bleeding, tranexamic acid should be administered as soon as possible, ideally within three hours of childbirth.