Carboprost is a prostaglandin analogue (15-methyl prostaglandin F2α) intended for the treatment of postpartum haemorrhage (PPH) due to uterine atony. Upjohn’s Hemabate contains carboprost 250μg in 1ml, and is given by deep intramuscular injection, but only as a second-line drug when conventional treatment with ergot derivatives and oxytocin have failed to stop haemorrhage. Careful clinical examination should first exclude other causes for such persistent bleeding, such as genital tract laceration or obvious retained placental fragments. The dose may be repeated after about one and a half hours if necessary. In the limited clinical studies it stopped bleeding in about 90% of patients after conventional treatment failed.1 Failure of treatment with carboprost is more likely when there are factors other than uterine atony, such as retained placental products. Diarrhoea, vomiting, fever and an increase in blood pressure each affect about 10% of patients. Asthma occurs occasionally and pulmonary oedema is a rare serious effect, so the drug is only safe to use in units with 24 hour medical cover. Two ampoules cost £33; its refrigerated shelf-life is 2 years.
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