Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Carbetocin (100 µg, intramuscularly/intravenously) is recommended for the prevention of postpartum haemorrhage for all births; the heat-stable carbetocin formulation is recommended in settings where cold chain cannot be guaranteed
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.
- 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.
- By “where cold chain cannot be guaranteed”, the GDG refers to settings in which continuous refrigeration (typically 2–8 °C) during storage, transport and handling of temperature-sensitive medicines cannot be consistently maintained because of infrastructure limitations, unreliable electricity supply or lack of temperature-monitoring systems. Many low- and middle-income countries, particularly in rural or remote areas, fall into this category.
- To maximize efficacy, carbetocin is best given immediately (preferably within 1 minute) after the birth of the baby or babies. Administration for the prevention of PPH need not impede the delaying of cord clamping.
- This recommendation applies only to the use of carbetocin for the prevention of PPH. Carbetocin is not currently recommended for other obstetric indications (such as labour induction, labour augmentation or treatment of PPH).
- The GDG noted that both heat-stable and non-heat-stable formulations of carbetocin are available. The heat-stable formulation differs from the non-heat-stable formulation only in its excipients and not in the active pharmaceutical ingredients. Heat-stable carbetocin does not require refrigeration and therefore eliminates the costs associated with refrigerated storage and transport for non-heat-stable uterotonics.
- The evidence underpinning this recommendation included both heat-stable and non-heat-stable formulations of carbetocin because the active pharmaceutical ingredients in these formulations are the same. Therefore, the recommendation applies to both formulations. In settings where reliable cold-chain storage and transport can be consistently maintained, the heat-stable formulation may not offer additional advantages and is not specifically required.
- Previous trials of carbetocin have used both intramuscular and intravenous administration. A WHO multi-country trial of nearly 30 000 women used a regimen of 100 μg intramuscular carbetocin (heat-stable formulation) in a range of high-, middle- and low-income settings.
- Previous trials of carbetocin have all been conducted in hospital settings. While the GDG acknowledged that the effectiveness of carbetocin in preventing PPH in community settings has not been evaluated in trials, the group agreed that there is no reason to expect differential effectiveness between hospital and community settings, provided that carbetocin is administered under similar conditions as other injectable uterotonics