title: Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review.
abstract: BACKGROUND
  Postpartum 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%.
  
  
  OBJECTIVE
  Overview on all available uterotonics for PPH prevention to clarify indications and contraindications in choice among drugs.
  
  
  METHODS
  Systematic review of the literature.
  
  
  RESULTS
  Oxytocin 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.
  
  
  CONCLUSIONS
  Prophylactic oxytocics should be offered routinely in the third stage of labor in all women. The prophylactic use of uterotonics should be individualized.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy. ginecologia_padova@libero.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Stefania Di
authors.initials: SD
authors.lastname: Gangi
authors.forename: Monica
authors.initials: M
authors.lastname: Carrozzini
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zambon
authors.forename: Anna
authors.initials: A
authors.lastname: Bertocco
authors.forename: Simone
authors.initials: S
authors.lastname: Fagherazzi
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D000818:Animals; D000075202:Contraindications; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics
keywords: active management; blood loss prevention; postpartum hemorrhage; third stage of labor; uterotonic drugs