Featured review: Uterotonic agents for preventing postpartum haemorrhage

Which drug is best for reducing excessive blood loss after birth?

The aim of this Cochrane Review was to find out which drug is most effective in preventing excessive blood loss at childbirth and has the least side effects. The authors collected and analysed all the relevant studies to answer this question.

The review’s lead author Dr Ioannis Gallos from the University of Birmingham explains, “Bleeding after birth is the most common reason why mothers die in childbirth worldwide. Although most women will have moderate bleeding at birth, others may bleed excessively, and this can pose a serious risk to their health and life. To reduce excessive bleeding blood loss at childbirth, the routine administration of a drug to contract the uterus (uterotonic) has become standard practice across the world. The aim of this research was to identify which drug is most effective in preventing excessive bleeding after childbirth and has the least side-effects.

The different drugs oxytocin, misoprostol, ergometrine, carbetocin, and combinations of these drugs, each have different effectiveness and side-effects. Some of the side effects identified include: vomiting, high blood pressure and fever. We analysed all the available evidence to compare all of these drugs and calculated a ranking among them providing robust effectiveness and side-effect profiles for each drug.

We found all drugs were generally effective for preventing excessive bleeding when compared with no uterotonic drug treatment. Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination may have some additional benefits compared with the current standard oxytocin. The two combination drugs, however, are associated with significant side effects that women might find disturbing compared with oxytocin. Carbetocin may have some additional benefits compared with oxytocin and appears to be without an increase in side effects.”

This updated review includes 196 studies involving 135,559 women. Studies were conducted across 53 countries. In most studies women were giving birth normally and in a hospital.