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• This recommendation applies to women giving birth vaginally or via caesarean section. Skilled health personnel who are trained to administer injectable uterotonics are required.
• The GDG advised that all women are to be provided with information – ideally during antenatal care – on the need for an effective uterotonic to prevent PPH.
• To maximize efficacy, oxytocin is best given immediately (preferably within 1 minute) after the birth of the baby or babies. Administration for prevention of PPH need not impede the delaying of cord clamping.
• The GDG noted that, to effectively prevent PPH and avoid potentially harmful haemodynamic side-effects at caesarean section, there was insufficient evidence from randomized controlled trials to recommend one oxytocin regimen over another. The group agreed that, in view of a number of observational studies suggesting dose-related side-effects (particularly hypotension and tachycardia), and potential effectiveness of oxytocin at doses much lower than 10 international units (IU), consideration needs to be given to dividing the recommended 10-IU dose between a smaller intravenous bolus and an infusion. A rapid intravenous bolus injection must be avoided. The GDG considered the identification of the optimal regimen of intravenous oxytocin at caesarean section to be an important research priority. For local adaptation of this recommendation as it applies to caesarean section, health systems need to ensure that adequate human resources exist to implement feasible intravenous oxytocin dosing strategies, without compromising the woman’s safety. Personnel administering oxytocin at caesarean section must be alert to the potential haemodynamic side-effects associated with intravenous oxytocin use, exercise caution in its administration and be prepared to provide effective resuscitation therapy should the need arise.
• Oxytocin is relatively inexpensive and widely available; however, it requires refrigerated transport and storage (2–8 °C). In settings where this cannot be guaranteed, the quality and effectiveness of oxytocin may be adversely affected. In these situations, an effective heat-stable uterotonic should be considered