What are the recommended pharmacological interventions for the prevention of postpartum haemorrhage in high-risk patients?

For the prevention of postpartum haemorrhage (PPH) in patients at high risk, specific pharmacological interventions are recommended depending on the mode of birth.

• For vaginal births with risk factors: If a woman has risk factors that could increase the risk of PPH, oxytocin plus ergometrine is advised as part of active management of the third stage of labour ¹. This combination may be more effective than oxytocin alone at reducing the risk of PPH ¹. It is administered as 5 units of oxytocin plus 500 micrograms of ergometrine by intramuscular injection immediately after the birth of the baby and before the cord is clamped and cut ¹.
• Considerations for oxytocin plus ergometrine: This combination is more likely to lead to nausea and vomiting compared with oxytocin alone ¹. Antiemetics, such as cyclizine, can be offered to women receiving oxytocin plus ergometrine ¹. It is contraindicated in women with severe hypertension, pre-eclampsia, eclampsia, or severe cardiac, hepatic, or renal disease ¹.
• For caesarean births: Carbetocin by slow intravenous injection is offered for the prevention of PPH ¹.
• General active management (if no specific risk factors for oxytocin plus ergometrine): For active management after vaginal birth, 10 units of oxytocin by intramuscular injection or 5 units of oxytocin by slow intravenous injection over 3 to 5 minutes (for women who received oxytocin during labour) can be administered immediately after birth and before cord clamping ¹.
• Interventions not routinely used for prevention: Umbilical oxytocin infusion or prostaglandin should not be used routinely in the third stage of labour for prevention ¹.