Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Uterotonics that are not recommended for the prevention of postpartum haemorrhage. Fixed-dose combination of oxytocin and ergometrine (5 IU/500 μg, intramuscularly) is not recommended for the prevention of postpartum haemorrhage
Not recommended
Notes and Remarks
- The fixed-dose combination of oxytocin and ergometrine (5 IU/500 µg, intramuscularly) (e.g. Syntometrine®) was previously included as a context-specific option in the 2018 WHO recommendations on uterotonics for the prevention of PPH, with the condition that hypertensive disorders could be safely excluded before use. However, in revisiting the evidence, the GDG decided to revise this recommendation by placing greater emphasis on the safety profile of uterotonics used for prophylaxis. The combination product contains a relatively high dose of ergometrine, which is now not recommended for routine use because of its association with adverse effects – particularly hypertension – and the availability of safer and comparably effective alternatives. In light of these concerns, and to ensure consistency across uterotonic guidance, the GDG recommended against the use of this fixed-dose combination for PPH prevention.
- Effective prophylactic uterotonics with better safety profiles and lower risk of serious adverse effects – such as oxytocin, carbetocin (heat-stable or non-heat-stable formulations) and misoprostol – are available and should be prioritized for procurement by health systems for the prevention of PPH. The GDG emphasized that the routine use of fixed-dose combination of oxytocin and ergometrine cannot be justified in light of its side-effect profile and the availability of safer alternatives. Countries are encouraged to update national guidelines, essential medicines lists, formularies and procurement lists accordingly, while recognizing that limited quantities of this combination may still be procured for treatment purposes, where clinically appropriate and aligned with WHO recommendations for the treatment of PPH.
- This recommendation applies to women giving birth vaginally or via caesarean section. The GDG highlighted that there is an added anaesthetic and surgical risk from nausea and vomiting for women having a caesarean birth, especially if under general anaesthesia, which further supports the recommendation against the prophylactic use of the fixed-dose combination.
- Most trials that evaluated the efficacy of this fixed-dose combination have used the synthetic, fixed-dose combination of oxytocin and ergometrine (5 IU/500 μg, intramuscularly), which informed the dose specified in this recommendation.
- This recommendation applies only to the use of fixed-dose combination of oxytocin and ergometrine for the prevention of PPH; it does not relate to its use in the treatment of PPH, where it may still be considered as part of second-line management