Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
In settings where multiple uterotonic options are available, oxytocin (10 IU, intramuscularly/intravenously) is the recommended uterotonic agent of choice for the prevention of postpartum haemorrhage for all births
Recommended
Notes and Remarks
- This recommendation applies to women giving birth vaginally or via caesarean section. Skilled health personnel who are trained to administer injectable uterotonics are required.
- All remarks for Recommendation 7.1 apply to this recommendation.
- While the GDG acknowledged that there is evidence that fixed-dose combination of oxytocin and ergometrine and combination of oxytocin and misoprostol may be more effective than oxytocin alone for some priority outcomes, there are concerns that these combinations also increase important side-effects for women. The fixed-dose combination of oxytocin and ergometrine is not widely available and there is no fixed-dose combination of oxytocin and misoprostol, so the two agents have to be administered through separate routes (parenteral and oral). Hence, the GDG considered the applications of these combinations less feasible when used routinely in clinical settings compared with using oxytocin or misoprostol alone as a single agent. This is consistent with the GDG position not to recommend the prophylactic use of fixed-dose combination of oxytocin and ergometrine because of concerns about safety. However, if the health worker and the woman regard the additional benefits of a combination of oxytocin and misoprostol (over either of these agents alone) as important in improving overall maternal outcomes, the use of this combination could be considered.