title: [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor].
abstract: OBJECTIVE
  To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH).
  
  
  METHODS
  We searched the Medline and the Cochrane Library (1st December 2004 to 1st March 2014) and we checked the international guidelines.
  
  
  RESULTS
  Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement).
authors.affiliation: Réseau périnatal Aurore, université Lyon-1, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; EA 4129, laboratoire « santé, individu, société », faculté de médecine Laennec, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France. Electronic address: corinne.dupont@chu-lyon.fr.
authors.forename: C
authors.initials: C
authors.lastname: Dupont
authors.affiliation: Pôle d'anesthésie-réanimation, maternité Jeanne de Flandre, CHRU de Lille, 59037 Lille cedex, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Ducloy-Bouthors
authors.affiliation: Réseau périnatal Aurore, université Lyon-1, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Inserm U846, Stem Cell and Brain Research Institute, 18, avenue Doyen-Lépine, 69675 Bron cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Huissoud
mesh_terms: D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy
keywords: Délivrance; Hémorragie du post-partum; Postpartum haemorrhage; Prevention; Prévention; Third stage of labor