From the Guidelines
Oxytocin is the best medication for postpartum hemorrhage prophylaxis, with a recommended dose of 5 to 10 IU administered via slow IV or intramuscular infusion at the time of shoulder release or immediate postpartum. This recommendation is based on the most recent guidelines for the management of urgent obstetric situations in emergency medicine, published in 2022 1. The standard regimen of oxytocin works by stimulating uterine contractions, which compress blood vessels at the placental site, reducing bleeding. It has a rapid onset of action and minimal side effects compared to alternatives.
Some key points to consider when administering oxytocin for postpartum hemorrhage prophylaxis include:
- The dose and route of administration, with 5 to 10 IU given via slow IV or intramuscular infusion being the recommended regimen 1
- The timing of administration, with the medication being given at the time of shoulder release or immediate postpartum 1
- The importance of proper uterine massage after medication administration to enhance the effectiveness of oxytocin
- The potential benefits of prophylactic administration of oxytocin in women with risk factors for postpartum hemorrhage, such as multiple gestation, polyhydramnios, macrosomia, or prolonged labor
It is worth noting that other medications, such as misoprostol, carboprost, methylergonovine, and tranexamic acid, may be used as alternatives to oxytocin in certain situations, but oxytocin remains the first-line choice for postpartum hemorrhage prophylaxis due to its efficacy and safety profile, as supported by the most recent guidelines 1.
From the FDA Drug Label
Oxytocin Injection, USP (synthetic) is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage. Methylergonovine maleate is a semi-synthetic ergot alkaloid used for the prevention and control of postpartum hemorrhage.
The best medication for postpartum hemorrhage prophylaxis is oxytocin (IV) or methylergonovine (IM), as both are indicated for the prevention and control of postpartum hemorrhage.
- Oxytocin (IV) is used to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage 2.
- Methylergonovine (IM) is used for the prevention and control of postpartum hemorrhage 3.
From the Research
Medications for Postpartum Hemorrhage Prophylaxis
- Oxytocin is widely recommended as the first-line uterotonic agent for the prevention of postpartum hemorrhage 4, 5, 6, 7
- Carbetocin, a long-acting analog of oxytocin, is likely the most effective single pharmacologic therapy for prevention of postpartum hemorrhage, although it is not yet available for use in the United States 4
- Combined therapy with oxytocin and other second-line uterotonics such as methylergonovine, misoprostol, and carboprost has an additive or synergistic effect and a greater risk reduction for postpartum hemorrhage prevention compared with oxytocin alone 4
- Tranexamic acid has been found to be both effective and safe for decreasing maternal mortality in women with postpartum hemorrhage, and prophylactic use of tranexamic acid may decrease the need for packed red blood cell transfusions and/or uterotonics 4
Administration of Oxytocin
- A standardized oxytocin administration protocol after delivery can reduce the treatment of postpartum hemorrhage 8
- Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of postpartum hemorrhage in patients with natural course of labor 6
- Higher-dose postpartum oxytocin may be associated with less postpartum hemorrhage treatment 8