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PPH drugs

Uterotonics and tranexamic acid in the order you reach for them.

Source: RCOG GTG 52 · NICE NG235 (2024)

OxytocinPrevention10 IU IM after vaginal birth (5 IU slow IV if oxytocin used in labour). At CS: 5 IU slow IV over 5 min.⚠ Never a rapid IV bolus — causes hypotension.

CarbetocinAt CS100 micrograms slow IV once after caesarean birth.⚠ Not routine for vaginal birth; not a PPH treatment (NICE 2024).

OxytocinPPH5 IU slow IV (may repeat), then 40 IU in 500 ml saline at 125 ml/h (over 4 h).⚠ Water intoxication with large volumes.

ErgometrinePPH500 micrograms IM (slow IV by anaesthetist only).⚠ Not in hypertension or pre-eclampsia.

SyntometrinePrevention1 ml IM (oxytocin 5 IU + ergometrine 500 micrograms).⚠ Normotensive women only; give an antiemetic.

CarboprostPPH250 micrograms deep IM; repeat no sooner than every 15 min; max 8 doses (2 mg).⚠ Avoid in asthma.

MisoprostolPPH800 micrograms sublingual or rectal.⚠ Fever and shivering common.

Tranexamic acidPPH1 g IV over 10 min; repeat 1 g after ≥30 min if still bleeding.⚠ Give within 3 h of bleeding onset. IV only — never intrathecal.

A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.