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Which Uterotonic Is Better to Prevent the Postpartum Hemorrhage? Latest News in Terms of Clinical Efficacy, Side Effects, and Contraindications: A Systematic Review

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Abstract

Background

Postpartum hemorrhage (PPH) is a potentially fatal complication of vaginal and cesarean deliveries. The active management of the third stage of labor provides administration of prophylactic uterotonic drugs just before or immediately after delivery, since they reduce the risk of PPH by 60%.

Objective

Overview on all available uterotonics for PPH prevention to clarify indications and contraindications in choice among drugs.

Search Strategy

Systematic review of the literature.

Main Results

Oxytocin is the first choice for PPH prophylaxis. Ergot alkaloids, syntometrine, and prostaglandins are second-line uterotonic agents. Misoprostol is not effective as oxytocin but it may be used when the latter is not available. Carbetocin should be used instead of continuous oxytocin infusion in elective cesarean sections for PPH prevention and to decrease the need for therapeutic uterotonics.

Conclusions

Prophylactic oxytocics should be offered routinely in the third stage of labor in all women. The prophylactic use of uterotonics should be individualized.

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Authors and Affiliations

  1. Department of Woman and Child Health, University of Padua, Giustiniani, 3, Padua, 35128, Italy

    Salvatore Gizzo MD, Stefania Di Gangi MD, Monica Carrozzini MD, Carlo Saccardi MD, PhD, Alessandra Zambon MD, Anna Bertocco MD, Simone Fagherazzi MD, Donato D’Antona MD & Giovanni Battista Nardelli MD

  2. Department of Obstetrics, Gynecological and Neonatology Sciences, University of Parma, Parma, Italy

    Tito Silvio Patrelli MD

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  1. Salvatore Gizzo MD
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Correspondence to Salvatore Gizzo MD.

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Gizzo, S., Patrelli, T.S., Di Gangi, S. et al. Which Uterotonic Is Better to Prevent the Postpartum Hemorrhage? Latest News in Terms of Clinical Efficacy, Side Effects, and Contraindications: A Systematic Review. Reprod. Sci. 20, 1011–1019 (2013). https://doi.org/10.1177/1933719112468951

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