Postpartum Haemorrhage
Excessive bleeding after childbirth, a leading cause of maternal mortality worldwide. Oxytocin is the first-line drug for both prevention and treatment — it stimulates uterine contraction to reduce bleeding. Oxytocin's inclusion on the WHO Essential Medicines List reflects its critical role in maternal health.
Technical Context
PPH is defined as blood loss ≥500mL after vaginal delivery or ≥1000mL after caesarean section. It is the leading cause of maternal mortality worldwide (approximately 70,000 deaths annually). Causes (the 4 Ts): Tone (uterine atony — most common, 70-80%), Tissue (retained placenta), Trauma (genital tract lacerations), and Thrombin (coagulopathy). Oxytocin is the cornerstone of PPH prevention and treatment: prophylactic oxytocin (10 IU IM or 5 IU slow IV) is recommended for all deliveries (WHO recommendation — reduces PPH incidence by approximately 50%). For treatment of atony: oxytocin infusion (20-40 IU in 1L normal saline at 250mL/hour). Carbetocin (a synthetic oxytocin analogue with longer half-life ~4-10× oxytocin) is approved in some countries for PPH prevention. Heat-stable carbetocin is particularly important for low-resource settings where cold chain maintenance is challenging.