Our Labor and Delivery department is requesting nitroglycerin injection to use for uterine relaxation in the setting of obstetric emergencies like uterine inversion.

I am hesitant to stock the 50 mg/250 ml (200 mcg/ml) NTG bottle. The obstetric IV push dose is only around 50 mcg/0.25 ml, which is 0.1% of the 250-ml bottle. Errors involving mg vs. mcg mix-ups or decimal place errors are certainly possible, especially considering the infrequent use of this medication.

What are other hospitals doing?

Do you give Labor and Delivery the full nitroglycerin 50 mg/250 ml bottle, provide unit-dose syringes (stability?), use the NTG spray, or some other practice?

I appreciate your help with this!