Pharmacologic Prevention and Treatment of Postpartum Hemorrhage

The purpose of this review is to synthetize the latest evidence on the pharmacological management of postpartum hemorrhage (PPH) and apply it to the clinical context. The incidence of PPH in the developed world is rising. Oxytocin and its analogue carbetocin remain the number one choice as first-line uterotonics for the prevention of PPH due to excellent clinical efficacy and a favorable side effect profile. Doses of oxytocin and carbetocin currently recommended for prophylaxis are in excess to that required for clinical efficacy. There is no robust evidence suggesting that one second-line uterotonic drug is superior to another. Tranexamic acid is safe and highly effective and should be administered both for cases at high risk for PPH as well as early in established hemorrhage. Choosing a uterotonic drug strategy that uses the most appropriate agent in the clinical context at the minimal effective dose is essential for improving maternal safety and the quality of postpartum care.