WHO recommendations on prevention of postpartum haemorrhage in caesarean section

WHO recommendations on prevention of postpartum haemorrhage in caesarean section

Recommendations

 

  • Oxytocin (IV or IM) is the recommended uterotonic drug for the prevention of PPH in caesarean section. (Strong recommendation, moderate-quality evidence)
  • Controlled cord traction is the recommended method for removal of the placenta in caesarean section. (Strong recommendation, moderate-quality evidence)

 

Date these recommendations were published: September 2012

 

Remarks

The GDG noted that, in terms of blood loss, there was not enough evidence to recommend oxytocin infusion over IV bolus injection. However, due to concerns regarding adverse haemodynamic effects, the GDG considered that if an IV bolus injection is used, a slow injection rate is preferred and a rapid injection rate should be avoided.

The GDG noted that the combination of an oxytocin infusion after an initial IV bolus of oxytocin after caesarean delivery reduces the need for additional uterotonic agents but does not affect the overall occurrence of major obstetric haemorrhage.

The GDG noted that carbetocin is associated with a reduction in the use of additional uterotonic agents but with no difference in the occurrence of major obstetric haemorrhage. In addition, the GDG noted that the use of carbetocin is considerably more expensive than oxytocin. This remark is equally applicable to vaginal deliveries.

 

Related links

WHO recommendations for the prevention and treatment of postpartum haemorrhage

Evidence Base and GRADE tables for these recommendations

 

Links to the supporting systematic reviews

Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev. 2008

Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012

Mahomed K, Sheehan S, Murphy DJ, Heatley E, Middleton P. Medical methods for preventing blood loss at caesarean section. Cochrane Database of Systematic Reviews. 2011

 

Resources

VIDEO: Active management of the third stage of labour
VIDEO: Caesarean section evidence-based surgical technique

Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors

Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice

 

These recommendations should be cited as: WHO Reproductive Health Library. WHO recommendations on postpartum haemorrhage prevention in caesarean section (last revised 2012). The WHO Reproductive Health Library; Geneva: World Health Organization.