Prevention
The active management of the third stage of labour significantly reduces the risk of PPH. Prophylactic oxytocics should be routinely used in the third stage of labour, as they decrease the risk of PPH by 60%.[1][2] For most women delivering vaginally, oxytocin 5 or 10 IU IM is the prophylactic agent of choice. It is used as an infusion for women having caesarean sections. Syntometrine® (oxytocin plus ergometrine) may also be used in the absence of hypertension. Although oxytocin is the management of choice, in low resource settings misoprostol is an alternative.[13][14] Its advantages are that it can be given orally. One study found it was more effective when given sublingually.[15]
Women at risk of PPH should be identified, and the place of their delivery planned accordingly.