WHO recommendation on uterine massage for prevention of postpartum haemorrhage

Illustration of uterine massage

WHO recommendation on uterine massage for prevention of postpartum haemorrhage



Sustained uterine massage is not recommended as an intervention to prevent postpartum haemorrhage (PPH) in women who have received prophylactic oxytocin.

(Not recommended)


Publication history

First published: September 2012

Updated: No update planned 

Assessed as up-to-date: September 2012



  • These recommendations have been integrated from the WHO recommendations for the prevention and treatment of postpartum haemorrhage, in which the GDG for that guideline determined them to be a conditional recommendations based on low-quality evidence (WHO recommendation on the use of sustained uterine massage in women who have received prophylactic oxytocin for the prevention of postpartum haemorrhage). 
  • There is a lack of evidence regarding the role of uterine massage for PPH prevention when no uterotonic drugs are used, or if a uterotonic drug other than oxytocin is used.  Although the GDG acknowledged that one small study reported that sustained uterine massage and clot expulsion were associated with a reduction in the use of additional uterotonics, there is lack of robust evidence supporting other benefits. However, the GDG considered that routine and frequent uterine tone assessment remains a crucial part of immediate postpartum care, particularly for the optimization of early PPH diagnosis.  Based on the most recent evidence, understanding about the contribution of each component of the active management of the third stage of labour package has evolved. The GDG considered that this package has a primary intervention: the use of a uterotonic. In the context of oxytocin use, CCT may add a small benefit, while uterine massage may add no benefit for the prevention of PPH. Early cord clamping is generally contraindicated.
  • The evidence supporting these recommendations can be found in the source guideline document, available at:



Related links

WHO recommendations on intrapartum care for a positive childbirth experience

(2018) - full document and evidence tables

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

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

WHO Programmes: Sexual and Reproductive health

Maternal Health


Citation: WHO Reproductive Health Library. WHO recommendation on sustained uterine massage for the prevention of postpartum haemorrhage (February 2018). The WHO Reproductive Health Library; Geneva: World Health Organization.