Postpartum blood loss with and without use of prophylactic carbetocin during .. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage. Postpartum haemorrhage (PPH) is the leading cause of maternal mortality Carbetocin may be an underused uterotonic for prevention of PPH. Postpartum haemorrhage (PPH) is defined as blood loss of ml or more within carbetocin versus prostaglandins for the prevention of PPH were reviewed.

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Evidence was extrapolated from one systematic review which evaluated a number of routes and doses of misoprostol versus injectable uterotonics for the prevention of PPH.

No significant difference was observed in the use of additional uterotonics in the four trials included the systematic review. Four trials compared intramuscular carbetocin and intramuscular syntometrine for women undergoing vaginal deliveries. Further information on evidence supporting this recommendation are available here.

Evidence related prevehting the use of various uterotonics was extrapolated from research on the prevention of PPH. The guideline will also be useful to Two review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. There was no statistically significant difference in terms of the haemogrhage for therapeutic uterotonic agents, but the risk of adverse effects such as nausea and vomiting were significantly lower in the carbetocin group: Pooled data also showed that carbetocin resulted in a lower risk of PPH compared to oxytocin in women who underwent caesarean delivery RR 0.

This video highlights the importance of social support provided by postparhum labour companions doulas during labour. Carbetocin is associated with less blood loss compared to syntometrine in the prevention of PPH for women who have vaginal deliveries and is associated with significantly fewer adverse effects.

What is the minimum effective dose of misoprostol for the treatment of PPH? This video provides an overview of performance of catheterization of the bladder. This group of independent experts used the evidence profiles to assess evidence on effects on harmorrhage pre-specified outcomes.


Rating the quality of evidence. This is, however, limited by the number of studies and risk of bias in the studies. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. It encourages health care decision-makers in these settings hhaemorrhage strive to make oxytocin available. Among the adverse outcomes rated as vor, higher rates of nausea RR 4. Misoprostol any route versus injectable uterotonics Evidence was extrapolated from one systematic review yaemorrhage evaluated a number of routes and doses of misoprostol versus injectable uterotonics for the prevention of PPH.

Postpartum haemorrhage PPH is defined as blood loss of ml or more within 24 hours after birth. The systematic review reported a reduction in the risk of PPH, with the use of carbetocin versus oxytocin for women who underwent caesarean section.

Managing Complications in Pregnancy and Childbirth: Evidence profiles in the form of GRADE tables were prepared for comparisons of interest, including the assessment and judgments for each outcome, and the estimated risks. Use of carbetocin resulted in a statistically significant postartum in the need for therapeutic uterotonics risk ratio RR 0.

Of the 60 patients in the group receiving IM prostaglandin, two required the use of additional uterotonics, compared to 10 of the 60 patients who received rectal misoprostol RR 0. Evidence came from one systematic review of 11 trials women which evaluated the effect of carbetocin mcg as an IV bolus or IM injection for the prevention of PPH after vaginal delivery and caesarean section versus oxytocin, fixed dose oxytocin-ergometrine, and placebo.

Treatment for primary postpartum haemorrhage. An enabling environment for example, by widening the availability of uterotonicsshould be created for the use of this recommendation for example, by widening the availability of crystalloid solutionincluding changes in the behaviour of health care practitioners to enable the use of evidence-based practices. Implementation considerations The successful introduction of evidence-based policies related to the prevention and management of PPH into national programmes and health care services depends on well-planned and participatory consensus-driven processes of adaptation and implementation.


Active versus expectant management for women in the third stage of labour. These processes may include the development or revision of national guidelines or protocols based on this recommendation.

WHO recommendation on the use of uterotonics for the treatment of postpartum haemorrhage (PPH)

Three of the trials were on women with no risk factor for PPH, while one trial was on women with risk factors for PPH. PPH is the primary cause of nearly one-fifth of all maternal deaths globally.

Intravenous oxytocin alone is the recommended uterotonic drug for the treatment of PPH. Updated planned for early Assessed as up-to-date: WHO recommendation on postnatal discharge hzemorrhage uncomplicated vaginal birth. Cochrane Database of Systematic Reviews. Oxytocin agonists for preventing postpartum haemorrhage.

Among the adverse outcomes rated as important, a higher rate of vomiting RR 3. We checked references of articles and communicated with authors and pharmaceutical industry contacts. GDG members discussed the balance between desirable and undesirable effects, overall quality of supporting evidence, values and preferences of stakeholders, resource requirements, cost-effectiveness, acceptability, feasibility and equity, to finalize the recommendation and remarks.

Carbetocin for preventing postpartum haemorrhage.

Evidence summary One Cochrane systematic review farbetocin conducted to assess the effectiveness and safety of any intervention used for the treatment of primary PPH. After an uncomplicated vaginal birth in a health care facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.

Research implications The GDG identified these research priorities related to this recommendation: Pregnancy, Childbirth, Postpartum and Newborn Care: