• Salvatore Gizzo, Tito Silvio Patrelli, Stefania Di Gangi, Monica Carrozzini, Carlo Saccardi, Alessandra Zambon, Anna Bertocco, Simone Fagherazzi, Donato D'Antona, and Giovanni Battista Nardelli.
• Department of Woman and Child Health, University of Padua, Padua, Italy. ginecologia_padova@libero.it
• Reprod Sci. 2013 Sep 1;20(9):1011-9.

BackgroundPostpartum 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%.ObjectiveOverview on all available uterotonics for PPH prevention to clarify indications and contraindications in choice among drugs.Search StrategySystematic review of the literature.Main ResultsOxytocin 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.ConclusionsProphylactic 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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