Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Intravenous oxytocin is the recommended uterotonic drug for the treatment of postpartum haemorrhage
Recommended
Notes and Remarks
- The GDG recommended intravenous oxytocin as the first-line uterotonic drug for the treatment of PPH, including when women have already received this drug for the prophylaxis of PPH. Repeated dosing is considered safe and effective when PPH develops despite prophylactic use.
- The GDG recognized that intravenous oxytocin may not be available in all settings. Health care decisionmakers are encouraged to prioritize the procurement and distribution of quality-assured oxytocin.
- For the treatment of PPH, 10 IU oxytocin is commonly administered intravenously as the initial dose. Rapid intravenous injection should be avoided to reduce the risk of hypotension and other adverse effects. The dose should preferably be diluted and administered slowly over 1–2 minutes as a bolus or diluted in a small volume of crystalloids and infused over 5–10 minutes. A maintenance infusion of oxytocin (10–20 IU diluted in crystalloids) may be required over the subsequent 4 hours to sustain uterine contraction and prevent recurrence of bleeding after initial control of PPH. The infusion should be titrated based on uterine response and clinical condition. Ongoing monitoring of blood loss, uterine tone and haemodynamic status throughout this period is essential to ensure treatment effectiveness and to enable timely escalation if bleeding continues or the woman’s condition deteriorates.
- The GDG acknowledged that there is limited evidence from studies on the best oxytocin regimen for the treatment of PPH and noted that variations in oxytocin regimen exist both in the initial and maintenance doses and the amount of fluids used for dilution. The regimen provided here reflects consensus and successful implementation in a large-scale PPH trial, which demonstrated its feasibility and favourable outcomes in four low- and middle-income countries.