Table 2.

Adjunct Medical Therapies for the Treatment of Severe PPH⁷⁵

Adjunct Medical Therapy	Utilization
Tranexamic acid	Recommended in PPH not resolved with first-line agents (uterotonics) Administer 1g IV May repeat 2nd dose if needed after 30 minutes if bleeding persists Do not exceed 2g in 24 hours Avoid in patients with renal disease
Desmopressin acetate	Indicated in postpartum bleeding in the setting of uremia, platelet dysfunction, and type 1 von Willebrand disease Usual dose: 0.3µg/kg May result in hyponatremia Decreased efficacy with repeated doses (tachyphylaxis)
Recombinant Factor VII	No evidence of improved survival Significant thrombotic risk Not recommended for routine use in PPH Consider use of lower doses to decrease thrombotic risk
Fibrinogen concentrates	Concentrated form of fibrinogen No need to thaw, minimal risks of infectious complications compared with cryoprecipitate Early use to maintain fibrinogen level above 200mg/dL suggested Initial dose commonly used between 2–3g Titrate further dosing based on serum fibrinogen levels
Prothrombin complex concentrates	Concentrates of human-derived vitamin K-dependent factors (II, VII, IX, X) First-line agent for urgent reversal of warfarin Limited evidence in non-warfarin-related hemorrhage If used during massive transfusion, consider lower doses than recommended for warfarin reversal to limit risk of thrombosis

Notes: Reproduced from Pacheco LD, Saade GR, Hankins GDV. Medical management of postpartum hemorrhage: an update. Semin Perinatol. 2019;43(1):22–26. Copyright 2019, withpermission from Elsevier.⁷⁵