Strategies in the prevention and management of postpartum hemorrhage: use of uterotonics

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide. Uterine atony is the primary underlying mechanism, and timely use of uterotonic agents is critical for its prevention and management. This article offers a comprehensive review of the main uterotonics, including oxytocin, carbetocin, ergot alkaloids, prostaglandins, and intravenous calcium, focusing on their pharmacodynamics, pharmacokinetics, clinical indications, and side effects. It addresses dosing differences in elective vs. intrapartum cesarean sections and in patients with morbid obesity. Carbetocin is highlighted for its utility in low-resource settings, while intravenous calcium shows promise as an adjunct, though lacks robust evidence for routine use. The importance of standardized protocols for sequential use of first- and second-line uterotonics is emphasized to optimize maternal outcomes and reduce the need for surgical interventions. This analysis provides practical, evidence-based tools to enhance obstetric care, particularly in surgical settings. The article concludes that individualized treatment and institutional implementation of clear guidelines are essential strategies to improve outcomes in PPH management.