Magnesium sulphate (eclampsia), oxytocin & misoprostol (PPH/labour induction), tranexamic acid.
WHO 2023 guidelines. Weight-based where applicable. Offline-capable.
For qualified healthcare professionals only.
Obstetric drug doses sourced from WHO recommendations on prevention and treatment of PPH (2023), WHO pre-eclampsia/eclampsia guidelines, BNF 2024, and national protocols for Nigeria (FMOH), Kenya (MOH), and Ghana (GHS).
Always apply clinical judgement. Report an error
✔
Clinically reviewed by
Dr. Hauwa Musa, FWACS
Consultant Obstetrician & Gynaecologist, National Hospital Abuja
Updated 2025-10-15
Step 1 — Country
Step 2 — Clinical Scenario
Step 3 — Patient Weight
kg
Required for MgSO₄ dosing; TXA for PPH is fixed-dose
Obstetric emergencies — including eclampsia, severe hypertension, postpartum haemorrhage, and sepsis — are the leading causes of preventable maternal mortality in sub-Saharan Africa. Nigeria has one of the highest maternal mortality ratios globally, estimated at 512 per 100,000 live births (WHO 2020). Rapid, accurate dosing of magnesium sulphate, antihypertensives, uterotonics, and tranexamic acid is critical to survival outcomes. This calculator covers the essential emergency obstetric medicines most needed in Nigerian and African district hospitals, based on WHO Emergency Obstetric Care guidelines, the WOMAN trial (TXA in PPH), the Magpie Trial (magnesium sulphate in eclampsia), and FMOH Nigeria obstetric emergency protocols.
Pritchard regimen (most widely used in Africa): 4g MgSO4 IV over 5–10 minutes + 5g IM into each buttock (total 14g loading). Maintenance: 5g IM every 4 hours. Zuspan regimen: 4g IV loading, then 1–2 g/hr IV infusion. Always monitor respiratory rate, urine output, and patellar reflexes. Antidote: calcium gluconate 1g IV.
Give tranexamic acid 1g IV slowly over 10 minutes within 3 hours of delivery for all PPH ≥500 mL. The WOMAN trial (20,000 women) showed TXA reduced PPH death by 19% when given within 3 hours. A second dose of 1g can be given if bleeding continues after 30 minutes or restarts within 24 hours. Effectiveness is time-sensitive — do not delay.
IV labetalol (20 mg bolus, repeat 40 mg, then 80 mg every 10 min, max 300 mg total) or IV hydralazine (5 mg bolus every 20 min) are first-line for acute severe hypertension in pregnancy (BP ≥160/110 mmHg). Oral nifedipine 10–20 mg is an effective alternative if IV access is unavailable. Avoid ACE inhibitors in pregnancy.
After the loading dose of 4–6 g IV over 15–20 minutes, magnesium sulphate maintenance is given as 1–2 g/hour by continuous IV infusion for at least 24 hours after the last seizure or delivery, whichever is later. If IV access is unavailable, the Magpie regimen uses IM maintenance: 5 g IM every 4 hours (alternating buttocks). Monitoring requirements include respiratory rate (must be ≥12/min), urine output (must be ≥25 mL/hour), and patellar reflexes (loss precedes respiratory arrest). Calcium gluconate 1 g IV is the antidote.
Misoprostol 600 micrograms sublingually or orally is recommended by WHO as an alternative uterotonic for PPH prevention when oxytocin is unavailable or cannot be stored appropriately (oxytocin is heat-sensitive and requires cold-chain). For PPH treatment, misoprostol 800 micrograms sublingual may be used if oxytocin is unavailable. It is the preferred uterotonic for community midwives and TBAs conducting deliveries without cold-chain access — a critical consideration in rural Nigeria, Kenya and Ghana.
Related calculators
For the full step-by-step postpartum haemorrhage protocol including shock index and uterotonic escalation, use the PPH Emergency Tool.
📋 Guideline basis: WHO PPH Guidelines 2012 · FMOH Nigeria · RCOG 2019 · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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