WHO recommendations for the prevention and treatment of postpartum haemorrhage

Published by World Health Organization on Apr 3, 2025

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Abstract

WHO Library Cataloguing-in-Publication Data

WHO recommendations for the prevention and treatment of postpartum haemorrhage. 1.Postpartum hemorrhage – prevention and control. 2.Postpartum hemorrhage – therapy. 3.Obstetric labor complications. 4.Guideline.

I.World Health Organization. ISBN 978 92 4 154850 2 (NLM classification: WQ 330)

© World Health Organization 2012

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Language

en

PICOS

PICO 10.1

Population
Women in third stage of labour
Intervention
Active management of third stage of labour
Comparator
Expectant management of third stage of labour
Outcomes

PICO 10.2

Population
Women in third stage of labour
Intervention
Oxytocin without active management
Comparator
Control
Outcomes

PICO 10.3

Population
Women in third stage of labour
Intervention
Prophylactic misoprostol (unsupervised administration)
Comparator
Placebo
Outcomes

PICO 10.4

Population
Women in third stage of labour
Intervention
Oxytocin
Comparator
Ergot Alkaloid
Outcomes

PICO 10.5

Population
Women in third stage of labour
Intervention
Oxytocin- Ergometrine IM (fixed dose combination)
Comparator
Oxytocin IV (any dose)
Outcomes

PICO 10.6

Population
Women in third stage of labour
Intervention
Oxytocin- Ergometrine IM (fixed dose combination)
Comparator
Oxytocin IM (any dose)
Outcomes

PICO 10.7

Population
Women in third stage of labour
Intervention
Oxytocin- Ergometrine IM (fixed dose combination
Comparator
Ergometrine IM (any dose)
Outcomes

PICO 10.8

Population
Women in third stage of labour
Intervention
Misoprostol 600mcg (oral)
Comparator
Injectable uterotonics
Outcomes

PICO 10.9

Population
Women in third stage of labour
Intervention
Misoprostol any dose (sublingual)
Comparator
Injectable uterotonics
Outcomes

PICO 10.10

Population
Women in third stage of labour
Intervention
Misoprostol 600mcg (sublingual)
Comparator
No uterotonics or placebo
Outcomes

PICO 10.11

Population
Women in third stage of labour
Intervention
Misoprostol 400mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 10.12

Population
Women in third stage of labour
Intervention
Misoprostol 600mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 10.13

Population
Women in third stage of labour
Intervention
Misoprostol 800mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 10.14

Population
Women in third stage of labour
Intervention
Intramuscular prostaglandins
Comparator
Injectable uterotonics
Outcomes

PICO 10.15

Population
Women in third stage of labour
Intervention
Injectable prostaglandins
Comparator
No uterotonics or placebo
Outcomes

PICO 10.16

Population
Women in third stage of labour
Intervention
Misoprostol
Comparator
Placebo
Outcomes

PICO 10.17

Population
Women in third stage of labour
Intervention
Oral Misoprostol (400μg)
Comparator
Placebo
Outcomes

PICO 10.18

Population
Women in third stage of labour
Intervention
Oral Misoprostol (400μg)
Comparator
No intervention
Outcomes

PICO 10.19

Population
Women in third stage of labour
Intervention
Misoprostol (Unsupervised community distribution)
Comparator
No intervention
Outcomes

PICO 20.1

Population
Women in third stage of labour
Intervention
Controlled cord traction
Comparator
No controlled cord traction
Outcomes

PICO 20.2

Population
Women in third stage of labour
Intervention
Early cord clamping
Comparator
Late cord clamping
Outcomes

PICO 20.3

Population
Women in third stage of labour
Intervention
Early cord clamping
Comparator
Delayed cord clamping
Outcomes

PICO 20.4

Population
Women in third stage of labour
Intervention
Uterine massage before placental delivery
Comparator
No uterine massage
Outcomes

PICO 20.5

Population
Women in third stage of labour
Intervention
Uterine massage (before or after placental delivery)
Comparator
No uterine massage
Outcomes

PICO 20.6

Population
Women in third stage of labour
Intervention
Uterine massage (after delivery of the placenta for 1-2 hours and empty the clots)
Comparator
No uterine massage
Outcomes

PICO 30.1

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Oxytocin (bolus and infusion)
Comparator
Oxytocin infusion only
Outcomes

PICO 30.2

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Oxytocin infusion only
Comparator
Oxytocin bolus and infusion
Outcomes

PICO 30.3

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Low dose oxytocin bolus
Comparator
High dose oxytocin bolus
Outcomes

PICO 30.4

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Low dose oxytocin infusion
Comparator
High dose oxytocin infusion
Outcomes

PICO 30.5

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Very low dose oxyticin bolus and infusion
Comparator
Higher dose oxyticin bolus and infusion
Outcomes

PICO 30.6

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Uterotonics alone (Carbetocin)
Comparator
Control
Outcomes

PICO 30.7

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Carbetocin
Comparator
Oxytocin
Outcomes

PICO 30.8

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Carbetocin
Comparator
Syntometrine
Outcomes

PICO 30.9

Population
Women in third stage of labour undergoing a caesarean section
Intervention
Manual removal of the placenta
Comparator
Controlled cord traction
Outcomes

PICO 40.1

Population
Women with postpartum haemorrhage
Intervention
Misoprostol
Comparator
Oxytocin /ergometrine
Outcomes

PICO 40.2

Population
Women with postpartum haemorrhage
Intervention
Adjunct Misoprostol
Comparator
Placebo
Outcomes

PICO 40.3

Population
Women with postpartum haemorrhage
Intervention
Oxytocin
Comparator
Ergometrine
Outcomes

PICO 40.4

Population
Women with postpartum haemorrhage
Intervention
Oxytocin- Ergometrine IM (fixed dose combination)
Comparator
Oxytocin IM (any dose)
Outcomes

PICO 40.5

Population
Women with postpartum haemorrhage
Intervention
Oxytocin- Ergometrine IM (fixed dose combination)
Comparator
Oxytocin 10IU IM
Outcomes

PICO 40.6

Population
Women with postpartum haemorrhage
Intervention
Oxytocin- Ergometrine IM (fixed dose combination)
Comparator
Oxytocin IV (any dose)
Outcomes

PICO 40.7

Population
Women with postpartum haemorrhage
Intervention
Oxytocin-Ergometrine IM (fixed dose combination)
Comparator
Ergometrine IM (any dose)
Outcomes

PICO 40.8

Population
Women with postpartum haemorrhage
Intervention
Carbetocin
Comparator
Oxytocin
Outcomes

PICO 40.9

Population
Women with postpartum haemorrhage
Intervention
Carbetocin
Comparator
Oxytocin
Outcomes

PICO 40.10

Population
Women with postpartum haemorrhage
Intervention
Carbetocin
Comparator
Oxytocin-Ergometrine (fixed dose combination)
Outcomes

PICO 40.11

Population
Women with postpartum haemorrhage
Intervention
Intramuscular prostaglandins
Comparator
Injectable uterotonics
Outcomes

PICO 40.12

Population
Women with postpartum haemorrhage
Intervention
Carboprost
Comparator
Misoprostol (rectal)
Outcomes

PICO 40.13

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 600mcg (oral)
Comparator
No uterotonics or placebo
Outcomes

PICO 40.14

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 600mcg (sublingual)
Comparator
No uterotonics or placebo
Outcomes

PICO 40.15

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 400mcg (rectal)
Comparator
No uterotonics or placebo
Outcomes

PICO 40.16

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 200mcg (buccal)
Comparator
No uterotonics or placebo
Outcomes

PICO 40.17

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 600mcg (oral)
Comparator
Injectable uterotonics
Outcomes

PICO 40.18

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 400mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 40.19

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 600mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 40.20

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 800mcg (rectal)
Comparator
Injectable uterotonics
Outcomes

PICO 40.21

Population
Women with postpartum haemorrhage
Intervention
Misoprostol any dose (sublingual)
Comparator
Injectable uterotonics
Outcomes

PICO 40.22

Population
Women with postpartum haemorrhage
Intervention
Misoprostol 400mcg (rectal)
Comparator
Intramuscular prostaglandins
Outcomes

PICO 50.1

Population
Women with postpartum haemorrhage
Intervention
Colloid and hypertonic crystalloid
Comparator
Isotonic crystalloid
Outcomes

PICO 50.2

Population
Women with postpartum haemorrhage
Intervention
Supplemental albumin
Comparator
Control
Outcomes

PICO 50.3

Population
Women with postpartum haemorrhage
Intervention
Colloid
Comparator
Crystalloid(add-oncolloid)
Outcomes

PICO 50.4

Population
Women with postpartum haemorrhage
Intervention
Colloid
Comparator
Hypertonic crystalloid
Outcomes

PICO 50.5

Population
Women with postpartum haemorrhage
Intervention
Tranexamic acid
Comparator
Pacebo or no treatment
Outcomes

PICO 60.1

Population
Women with postpartum haemorrhage
Intervention
Uterine massage before placental delivery
Comparator
No uterine massage
Outcomes

PICO 60.2

Population
Women with postpartum haemorrhage
Intervention
Uterine massage (after placental delivery)
Comparator
No uterine massage
Outcomes

PICO 60.3

Population
Women with postpartum haemorrhage
Intervention
Uterine massage before or after placental delivery
Comparator
No uterine massage
Outcomes

PICO 60.4

Population
Women with postpartum haemorrhage
Intervention
Uterine balloon tamponade
Comparator
Standard care
Outcomes

PICO 60.5

Population
Women with postpartum haemorrhage
Intervention
Artery embolization
Comparator
Standard care
Outcomes

PICO 60.6

Population
Women with postpartum haemorrhage
Intervention
Surgical Interventions
Comparator
Standard care
Outcomes

PICO 60.7

Population
Women with postpartum haemorrhage
Intervention
Bimanual uterine compression
Comparator
Standard care
Outcomes

PICO 60.8

Population
Women with postpartum haemorrhage
Intervention
External aortic compression
Comparator
Standard care
Outcomes

PICO 60.9

Population
Women with postpartum haemorrhage
Intervention
Non-pneumatic anti-shock garments
Comparator
Standard care
Outcomes

PICO 60.10

Population
Women with postpartum haemorrhage
Intervention
Uterine packing
Comparator
Standard care
Outcomes

PICO 70.1

Population
Women with retained placenta
Intervention
Uterotonics
Comparator
Control
Outcomes

PICO 70.2

Population
Women with retained placenta
Intervention
Intraumbilical injection of saline solution
Comparator
Expectant management
Outcomes

PICO 70.3

Population
Women with retained placenta
Intervention
Intraumbilical injection of oxytocin
Comparator
Expectant management
Outcomes

PICO 70.4

Population
Women with retained placenta
Intervention
Intraumbilical injection of oxytocin
Comparator
Saline solution
Outcomes

PICO 70.5

Population
Women with retained placenta
Intervention
Intraumbilical injection of prostaglandin solution
Comparator
Saline solution
Outcomes

PICO 70.6

Population
Women with retained placenta
Intervention
Intraumbilical injection of prostaglandin solution
Comparator
Oxytocin solution
Outcomes

PICO 70.7

Population
Women with retained placenta
Intervention
Oxytocin solution
Comparator
Plasma expander
Outcomes

PICO 70.8

Population
Women with manual removal of the retained placenta
Intervention
Antibiotics
Comparator
No antibiotics
Outcomes

PICO 80.1

Population
Women with postpartum haemorrhage
Intervention
Use of standard protocol
Comparator
No protocol
Outcomes

PICO 80.2

Population
Women with postpartum haemorrhage
Intervention
Formal protocol for the referral
Comparator
No protocol
Outcomes

PICO 80.3

Population
PPH
Intervention
Simulation for PPH treatment in training programs
Comparator
No simulation
Outcomes

PICO 80.4

Population
PPH
Intervention
Monitoring the use of uterotonics
Comparator
No monitoring
Outcomes

PICO 90.1

Population
Women in third stage of labour
Intervention
Quantitative estimation
Comparator
Visual estimation
Outcomes