Recommendations
1. Identification of risk factors for PPH should occur in an ongoing manner throughout the course of care. (III-B)
2. Active management should be offered to all pregnant women. (I-A)
3. Active management is strongly recommended for women with an identified increased risk of postpartum hemorrhage. (I-A)
4. When active management is employed, prophylactic oxytocin (given as 10 IU IM or 5 IU IV slow push) should be given after delivery of the anterior shoulder within up to one minute after delivery of the infant. (I-B)
5. When active management is employed, clamping of the cord can occur immediately after delivery of the infant or when pulsation ceases. (I-C)
6. Controlled cord traction may be used to decrease blood loss, and should be used in combination with counter traction above the pubic bone on a contracted uterus. (I-B)
7. Either expectant management or the BrandtAndrews manoeuvre is an acceptable option for women who decline active management. (III)
8. When PPH occurs, the cause of bleeding should be identified and directed treatment undertaken promptly. (III)
9. In addition to controlling bleeding, the initial steps in treatment of PPH should include treating shock and communicating