Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For the prevention of postpartum haemorrhage (PPH) in patients at high risk, specific pharmacological interventions are recommended depending on the mode of birth.
- For vaginal births with risk factors: If a woman has risk factors that could increase the risk of PPH, oxytocin plus ergometrine is advised as part of active management of the third stage of labour NICE NG235. This combination may be more effective than oxytocin alone at reducing the risk of PPH NICE NG235. It is administered as 5 units of oxytocin plus 500 micrograms of ergometrine by intramuscular injection immediately after the birth of the baby and before the cord is clamped and cut NICE NG235.
- Considerations for oxytocin plus ergometrine: This combination is more likely to lead to nausea and vomiting compared with oxytocin alone NICE NG235. Antiemetics, such as cyclizine, can be offered to women receiving oxytocin plus ergometrine NICE NG235. It is contraindicated in women with severe hypertension, pre-eclampsia, eclampsia, or severe cardiac, hepatic, or renal disease NICE NG235.
- For caesarean births: Carbetocin by slow intravenous injection is offered for the prevention of PPH NICE NG235.
- General active management (if no specific risk factors for oxytocin plus ergometrine): For active management after vaginal birth, 10 units of oxytocin by intramuscular injection or 5 units of oxytocin by slow intravenous injection over 3 to 5 minutes (for women who received oxytocin during labour) can be administered immediately after birth and before cord clamping NICE NG235.
- Interventions not routinely used for prevention: Umbilical oxytocin infusion or prostaglandin should not be used routinely in the third stage of labour for prevention NICE NG235.