WHO Releases Updates Guidelines on Oxytocin Use for Postpartum Hemorrhage Prevention
USA: The World Health Organization (WHO) has issued updated guidelines on the administration of oxytocin for the prevention of postpartum hemorrhage (PPH) following vaginal birth. PPH, defined as a blood loss of 500 mL or more within 24 hours after delivery, remains a leading cause of maternal mortality, particularly in low-income countries. These recommendations aim to enhance care during childbirth and support global health goals, including reducing maternal mortality to fewer than 70 per 100,000 live births by 2030.
The WHO recommends administering 10 international units (IU) of oxytocin intramuscularly or intravenously to prevent PPH in all vaginal births. In cases where women already have intravenous (IV) access, slow IV administration is preferred due to its superior health outcomes. Evidence indicates that IV oxytocin reduces the risk of PPH, severe PPH, the need for blood transfusions, and severe maternal complications compared to intramuscular (IM) administration.
"Oxytocin (10 international units [IU]) is recommended for preventing postpartum hemorrhage in all births, administered either intramuscularly or intravenously. For women undergoing vaginal delivery who already have intravenous access, the slow intravenous administration of 10 IU oxytocin is preferred over intramuscular administration," the WHO stated.
However, the WHO cautions against routine IV access solely for oxytocin administration, emphasizing its feasibility and the potential impact on resources, health equity, and maternal comfort. The guideline advises that IV oxytocin be administered slowly to mitigate potential safety risks, such as hemodynamic changes, associated with rapid IV bolus injections.
While both IV and IM routes effectively prevent PPH, the updated recommendation underscores the importance of tailoring practices to specific clinical contexts. For example, in settings where IV access is not routinely available, IM oxytocin remains a reliable option.
The updated guidance reflects the WHO’s rigorous review process, which includes systematic evidence assessments and consultations with global experts. These recommendations supersede those issued in the 2012 guideline on PPH prevention and address the latest evidence to guide healthcare providers, policy-makers, and program managers worldwide.
The WHO emphasizes that the effective prevention of PPH requires more than just clinical interventions; it involves addressing inequities in maternal health and ensuring the availability of skilled healthcare personnel, adequate resources, and evidence-based practices. By implementing these guidelines, the global community takes a crucial step toward improving maternal health outcomes and reducing disparities in care.
This latest update aligns with WHO’s broader mission to enhance maternal and perinatal health, ensuring that childbirth is safer for all women, regardless of their geographic or socioeconomic circumstances.
Reference:
WHO recommendation on routes of oxytocin administration for the prevention of postpartum haemorrhage after vaginal birth. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
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