Guideline

WHO recommendations Uterotonics for the prevention of postpartum haemorrhage

Year of Publication

2018

Issuing Institution

World Health Organization

Links

Recommendations

10 included recommendations

The use of an effective uterotonic for the prevention of postpartum haemorrhage during the third stage of labour is recommended for all births. To effectively prevent postpartum haemorrhage, only one of the following uterotonics should be used: " oxytocin " carbetocin " misoprostol " ergometrine/methylergometrine " oxytocin and ergometrine fixed-dose combination

Status

Updated

Recommended

The use of oxytocin (10 IU, IM/IV) is recommended for the prevention of postpartum haemorrhage for all births

Status

Updated

Recommended

Certainty of evidence

Moderate

The use of carbetocin (100 µg, IM/IV) is recommended for the prevention of postpartum haemorrhage for all births in contexts where its cost is comparable to other effective uterotonics

Status

Updated

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

The use of misoprostol (either 400 µg or 600 µg, PO) is recommended for the prevention of postpartum haemorrhage for all births

Status

Updated

Recommended

Certainty of evidence

Moderate

The use of ergometrine/methylergometrine (200 µg, IM/IV) is recommended for the prevention of postpartum haemorrhage in contexts where hypertensive disorders can be safely excluded prior to its use

Status

Updated

Context specific recommendation

Only in specific contexts

The use of a fixed-dose combination of oxytocin and ergometrine (5 IU/500 µg, IM) is recommended for the prevention of postpartum haemorrhage in contexts where hypertensive disorders can be safely excluded prior to its use

Status

Updated

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Injectable prostaglandins (carboprost or sulprostone) are not recommended for the prevention of postpartum haemorrhage

Status

Updated

Not recommended

Certainty of evidence

Very low

In settings where multiple uterotonic options are available, oxytocin (10 IU, IM/ IV) is the recommended uterotonic agent for the prevention of postpartum haemorrhage for all births

Status

Updated

Recommended

In settings where oxytocin is unavailable (or its quality cannot be guaranteed), the use of other injectable uterotonics (carbetocin, or if appropriate ergometrine/ methylergometrine, or oxytocin and ergometrine fixed-dose combination) or oral misoprostol is recommended for the prevention of postpartum haemorrhage

Status

Updated

Recommended

In settings where skilled health personnel are not present to administer injectable uterotonics, the administration of misoprostol (either 400 µg or 600 µg, PO) by community health workers and lay health workers is recommended for the prevention of postpartum haemorrhage

Status

Updated

Recommended