Context | Recommendation |
Efficacy and safety of uterotonics for PPH prevention | 1. The use of an effective uterotonic for the prevention of PPH during the third stage of labour is recommended for all births. To effectively prevent PPH, only one of the following uterotonics should be used:
|
1.1 The use of oxytocin (10 IU, IM/IV) is recommended for the prevention of PPH for all births. | |
1.2 The use of carbetocin (100 µg, IM/IV) is recommended for the prevention of PPH for all births in contexts where its cost is comparable to other effective uterotonics. | |
1.3 The use of misoprostol (either 400 µg or 600 µg, PO) is recommended for the prevention of PPH for all births. | |
1.4 The use of ergometrine/methylergometrine (200 µg, IM/IV) is recommended for the prevention of PPH in contexts where hypertensive disorders can be safely excluded prior to its use. | |
1.5 The use of oxytocin and ergometrine fixed-dose combination (5 IU/500 µg, IM) is recommended for the prevention of PPH in contexts where hypertensive disorders can be safely excluded prior to its use. | |
1.6 Injectable prostaglandins (carboprost or sulprostone) are not recommended for the prevention of PPH. | |
Choice of uterotonics for PPH prevention | 2. In settings where multiple uterotonic options are available, oxytocin (10 IU, IM/IV) is the recommended uterotonic agent for the prevention of PPH for all births. |
3. 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 PPH. | |
4. In settings where skilled health personnel are not present to administer injectable uterotonics, the administration of misoprostol (400 µg or 600 µg PO) by community healthcare workers and lay health workers is recommended for the prevention of PPH. |
IM, intramuscular; IV, intravenous; PO, per oral; PPH, postpartum haemorrhage.