Use and health system requirements | Uterotonics | Non-uterotonic | |||
Oxytocin | Misoprostol | Heat-stable carbetocin* | Ergometrine† | Tranexamic acid | |
PPH prevention | Recommended‡ | Recommended | Recommended | Recommended | Not recommended |
PPH treatment | Recommended‡ | Recommended | Not recommended | Recommended | Recommended |
Labour induction | Recommended | Recommended | Not recommended | Contraindicated | Not recommended |
Labour augmentation | Recommended | Contraindicated | Contraindicated | Contraindicated | Not recommended |
Abortion care | Not recommended | Recommended§ | Not recommended | Not recommended | Not recommended |
Postabortion care | Not recommended | Recommended | Not recommended | Not recommended | Not recommended |
Administration route | Intravenous, IM | Oral, sublingual, vaginal¶ | Intravenous, IM | Intravenous, IM | Intravenous |
Skilled health provider requirement | Yes | No | Yes | Yes | Yes |
Cold chain transport and storage requirement | Yes (2°C–8°C) | No (but ≤25°C) in double aluminium blisters | No (but ≤30°C) | Yes (2°C–8°C) away from light | No |
Presentation** | 10 IU ampoule | 200 mcg tablet†† | 100 mcg in 1 mL ampoule | Ergometrine maleate 0.2 mg/mL in 1 mL ampoule | 100 mg/mL in 10 mL ampoule |
Price per unit** | US$0.334 per ampoule | US$0.054 per oral tablet of 200 mcg | US$0.413 per ampoule | US$0.219 per ampoule | US$1.30 per ampoule |
The colour shadings reflecting a traffic light approach (red, orange and green) were used to give the reader an instant recognition of the level of caution that is needed in regards to the use of the uterotonics and non-uterotonics in different clinical situations. The use of lighter orange and grey in rows 10 and below of table 1 were to help the reader easily identify which uterotonics and non uterotonics required a skilled health provider for their administration and which required a cold chain transport and storage requirement.
*Heat-stable carbetocin: only in contexts where its cost is comparable to that of other effective uterotonics.
†Ergometrine: only in contexts where hypertensive disorders can be safely ruled out before use. Ergometrine refers to ergometrine/methylergometrine.
‡First line.
§Alone or preceded by mifepristone.
¶The vaginal route is not recommended for PPH prevention and treatment.
**Per UNFPA Product Catalogue (2021).
††The 25 mcg oral or vaginal tablet is not in the 2021 UNFPA Product Catalogue. The 200 mcg tablet must not be divided into 25 mcg portions, as this is virtually impossible to be achieved precisely by hand.
IM, intramuscular; IU, international units; PPH, postpartum haemorrhage; UNFPA, Product Catalogue of the United Nations Population Fund.