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. Ergometrine/methylergometrine is not recommended for the prevention of postpartum haemorrhage
Not recommended
Notes and Remarks
- Ergometrine/methylergometrine was previously included in the 2018 WHO recommendations on uterotonics as a context-specific option for PPH prevention, with the condition that it is used only when hypertensive disorders could be safely excluded. Upon review of updated evidence, the GDG noted that it offers limited clinical benefit and remains associated with a high risk of adverse effects, particularly hypertension. In view of these safety concerns, the GDG concluded that ergometrine/methylergometrine is not recommended for the prevention of PPH in current practice, in favour of uterotonics with a more favourable balance of effectiveness and safety.
- Effective prophylactic uterotonics with better safety profiles and less risk of concerning adverse effects – 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 prophylactic use of ergometrine cannot be justified, given the absence of clear added benefit over safer alternatives. Countries are encouraged to update national guidelines, essential medicines lists, formularies and procurement lists to reflect this recommendation, while recognizing that ergometrine may still be procured in limited quantities for treatment purposes, in line with WHO recommendations for the treatment of PPH
- This recommendation applies to women undergoing a vaginal birth or caesarean section.
- The GDG acknowledged that ergometrine and methylergometrine injections (200–500 µg, intramuscularly/ intravenously) continue to be widely used in some countries for the prevention of PPH, largely because of historical practice patterns and routine procurement systems. However, the current evidence does not support their continued use for this indication.
- Ergometrine/methylergometrine is associated with a range of undesirable side-effects – most notably hypertension – which may pose significant risks, particularly for women with undiagnosed or pre-existing cardiovascular conditions.
- This recommendation applies only to the use of ergometrine/methylergometrine for 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