{ "release_id": "fc5a600ec7387e71", "id": "maternal:uterotonic-pph-prevention", "owner": "maternal", "kind": "intervention", "slug": "uterotonic-pph-prevention", "name": "Medicine to prevent heavy bleeding right after birth (oxytocin or another uterotonic)", "aliases": [], "atlases": [ "maternal" ], "summary_plain": "After the baby is born, the womb has to contract firmly to stop bleeding. A medicine that makes it contract is called a uterotonic. WHO recommends that every woman who gives birth is offered one quality-assured uterotonic straight after the birth to lower the risk of heavy bleeding. It names oxytocin, carbetocin and misoprostol and says only one should be used. This page is about prevention after birth, which is a different use of oxytocin from starting labour.", "summary_technical": "Medicine strategy for the third stage of labour. WHO 2025 Recommendation 7 (Updated, Recommended): a quality-assured uterotonic for all births; 7.1 oxytocin 10 IU intramuscularly or intravenously; 7.2 carbetocin 100 micrograms intramuscularly or intravenously, heat-stable where the cold chain cannot be guaranteed; 7.3 misoprostol 400 or 600 micrograms orally; Recommendation 10: oxytocin is the agent of choice where several are available; Recommendation 11: heat-stable carbetocin where the oxytocin cold chain cannot be maintained. The recommendation applies to vaginal and caesarean births and needs skilled staff for injectable uterotonics. The CHAMPION trial compared heat-stable carbetocin with oxytocin. Evidence for oxytocin to start labour does not carry over to this use, and the reverse also holds.", "editorial_state": "draft", "last_substantive_edit": "2026-10-14", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "childbirth", "postpartum" ], "care-area": [ "postpartum-recovery" ] } }, "payload": { "subtype": "medicine", "mechanism": null, "components": null }, "content_digest": "9a8587625cba5dd8b120c3398d16eb6da596f341073dbd1e081f3a8448e83b4c", "review": { "content_digest": "9a8587625cba5dd8b120c3398d16eb6da596f341073dbd1e081f3a8448e83b4c", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "fc5a600ec7387e71", "id": "maternal:claim-uterotonic-pph-prevention-who-2025", "owner": "maternal", "subject_entity_id": "maternal:uterotonic-pph-prevention", "category": "recommendation", "statement": "WHO 2025 recommends a quality-assured uterotonic to prevent postpartum haemorrhage during the third stage of labour for all births (Recommendation 7, category Recommended, status Updated). Only one uterotonic should be used: oxytocin, carbetocin or misoprostol, as set out in Recommendations 7.1 to 7.3. The recommendation applies to women giving birth vaginally or by caesarean section, and skilled health personnel trained to give injectable uterotonics are required. Oxytocin is best given immediately, preferably within 1 minute after the baby is born, and needs refrigeration at 2 to 8 degrees Celsius.", "context": { "id": "maternal:ctx-who-2025-pph-prevention-all-births", "label": "All women giving birth, third stage of labour, prevention of postpartum haemorrhage (WHO 2025 Recommendation 7)", "recipient": "maternal", "population": "All women giving birth, vaginally or by caesarean section, receiving a uterotonic in the third stage of labour to prevent postpartum haemorrhage. WHO says skilled health personnel trained to give injectable uterotonics are required. This is prevention, before bleeding starts, and is a different use of oxytocin from starting or strengthening labour.", "care_setting": "Not stated in the source", "geography": "Global (WHO guidance intended to inform national and subnational policy).", "life_stage_note": "Childbirth, third stage of labour", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Any woman giving birth, by vaginal birth or caesarean section" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "WHO 2025 labels each recommendation with one of four categories and a development status. These are not GRADE strength labels, so the claim certainty is left not assessed. The evidence behind the recommendation is in WHO's web annex, which was not read. This claim is about preventing bleeding after birth. It does not cover oxytocin used to start or strengthen labour, which has its own records and a different evidence base. The guideline names oxytocin as the agent of choice where several uterotonics are available (Recommendation 10) and heat-stable carbetocin where the oxytocin cold chain cannot be maintained (Recommendation 11, a separate claim).", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Summary list of recommendations, Recommendation 7: text and category", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-011563-7", "normalized_value": "9789240115637", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "edition": "First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote", "replaced_by": null, "retirement_note": null } }, { "evidence_role": "supports", "locator": "Recommendation 7.1, Remarks: scope, skilled personnel, timing, cold storage", "applicability_note": "WHO 2025 consolidated guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240115637-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:12:00Z", "content_hash": "2049fb40dff7e97712c98cb58907ef662161627197a5e143ec50045abb1931de", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2025-pph-consolidated", "source_type": "guideline", "title": "Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage", "canonical_url": "https://www.who.int/publications/i/item/9789240115637", "identifiers": [ { "scheme": "isbn", "value": "978-92-4-011563-7", "normalized_value": "9789240115637", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2025-10-05", "publisher": "World Health Organization, co-published with the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM)", "edition": "First edition, 2025. The date is the who.int page date, 5 October 2025, which the atlas uses for WHO sources and decisions; the WHO IRIS record lists an issue date of 2025-09-26 for the same document. The web annexes with the evidence base and the implementation guide were not read.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF and in the IRIS record. Only short quotations with attribution are used, and neither the PDF nor the pages are committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote", "replaced_by": null, "retirement_note": null } } ], "review": { "content_digest": "cab46cd8eb32a8f10aed3a382d0e3afd3f596614681053fd1d50a7fda668da03", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-uterotonic-pph-prevention-who-2025.json" } ], "decisions": [ { "type": "recommendation", "id": "maternal:rec-who-2025-uterotonic-all-births", "direction": "for", "intervention_id": "maternal:uterotonic-pph-prevention", "context_id": "maternal:ctx-who-2025-pph-prevention-all-births", "guideline_snapshot_id": "maternal:who-9789240115637-pdf-2026-10-11", "guideline_id": "maternal:pub-who-2025-pph", "issuer_id": "maternal:who", "jurisdictions": [ "GLOBAL" ], "jurisdiction_note": "Global (WHO guidance intended to inform national and subnational policy). Co-published with FIGO and ICM.", "strength_label": "Recommended", "strength_system": "WHO 2025 consolidated PPH guideline. Each recommendation falls in one of four categories (Recommended, Not recommended, Recommended only in specific contexts, Recommended only in the context of rigorous research) and carries a development status (New, Updated, Revalidated or Edited). These are not GRADE strength labels. Recommendation 7 is Updated.", "effective_date": "2025-10-05", "effective_date_note": "The who.int page date, 5 October 2025 (2025-10-05), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2025-09-26. Both dates are kept.", "superseded_by": null, "supersession_status": null, "claim_id": "maternal:claim-uterotonic-pph-prevention-who-2025" } ], "milestones": [], "relationships": { "outgoing": [ { "predicate": "recommended_for", "label": "WHO 2025 Recommendation 7: a uterotonic for all births", "clinical_claim_not_fact": true, "family": "clinical", "other_entity_id": "maternal:postpartum-hemorrhage", "other_entity_in_atlas": true, "claim_id": "maternal:claim-uterotonic-pph-prevention-who-2025", "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "part_of", "label": "Filed under this front", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "maternal:front-medicines-and-vaccines", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": true, "role": null, "valid_from": null, "valid_to": null } ], "incoming": [ { "predicate": "related_to", "label": "Related to", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "maternal:carbetocin", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "related_to", "label": "Related to", "clinical_claim_not_fact": false, "family": "navigation", "other_entity_id": "maternal:oxytocin", "other_entity_in_atlas": true, "claim_id": null, "evidence": null, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "investigates", "label": "Investigated in", "clinical_claim_not_fact": false, "family": "sourced", "other_entity_id": "maternal:champion-trial", "other_entity_in_atlas": true, "claim_id": null, "evidence": { "snapshot_id": "maternal:pubmed-29949473-2026-10-14", "locator": "Abstract, CONCLUSIONS, sentence 1" }, "primary": false, "role": null, "valid_from": null, "valid_to": null } ] }, "page_path": "interventions/uterotonic-pph-prevention/", "context_path": "api/v1/context/maternal--uterotonic-pph-prevention.md" }