产后大出血

大多数国家的指引建议在第三阶段预防性应用催产素，同时推荐所有高风险分娩中使用。可选择的催产素有：子宫收缩药麦角新碱，米索前列醇和卡贝缩官素。每个选择之间的剂量相差很大。

Available guidelines

Region	Country	Date	Source url	Active treatment of 3rd stage labour	PPH prophylaxis
Europe	Austria	2011	n/a	• Oxytocin and carbetocin	Vaginal deliveries 1. Oxytocin (3–5 IU IV)
Europe	Czech Republic	2011	Link	1. Oxytocin, carbetocin or methylergometrine	Caesarean sections 1. Oxytocin or carbetocin 2. Controlled cord traction 3. Cord clamping and cutting
Europe	Denmark	2013	n/a	1. Syntocinon (40–80 IU diluted and administered via infusion pump at a rate of 180 mL/hour) 2. Cytotec (0.4 mg sublingual/rectal) 3. Methylergometrine (0.2 mg IM) 4. Carboprost (Prostinfenem; 0.25 mg/mL IM) 5. Carbetocin (100 mcg slow IV)	Vaginal and caesarean deliveries 1. Syntocinon (40–80 IU diluted and administered via infusion pump at a rate of 180 mL/hour) 2. Cytotec (0.4 mg sublingual/rectal) 3. Methylergometrine (0.2 mg IM) 4. Carboprost (0.25 mg/mL IM) 5. Carbetocin (100 mcg slow IV)
Europe	Finland	n/a	n/a	• Oxytocin (50 IU) or Cytotec (600–1200 mcg) administered rectally every 3–4 hours	n/a
Europe	France	2004	Link	• Oxytocin	Vaginal and caesarean deliveries • Syntocinon (10 IU IM or 5 IU slow IV infusion)
Europe	Italy	2009	n/a	• Oxytocin	Vaginal and caesarean deliveries • Oxytocin (10 IU IM or 5 IU IV) or syntometrine immediately after delivery of the baby or before removal of the placenta, followed by oxytocin (5–20 IU IV fusion in 500 mL of physiologic solution)
Europe	Norway	2014	Link	• Oxytocin 5 IU IM (repeat once, if necessary)	Vaginal and caesarean deliveries • Oxytocin 5 IU IM
Europe	Poland	2013	n/a	1. Oxytocin 2. Carbetocin	n/a
Europe	Portugal	n/a	n/a	• Oxytocin	n/a
Europe	Romania	2009	Link	• Oxytocin or methylergometrine	Vaginal and caesarean deliveries • Oxytocin or methylergometrine
Europe	Russia	2013	Link	1. Carbetocin 100 mcg IM or oxytocin 20 IU IM 2. Misoprostol is used in approximately 20% cases of PPH	Vaginal and caesarean deliveries 1. Carbetocin 100 mcg and oxytocin (5–10 IU IV infusion)
Europe	Spain	2006	Link	1. Oxytocin 2. Methylergometrine 3. Carboprost (Hemabate) or misoprostol	Vaginal and caesarean deliveries • Oxytocin
Europe	Sweden	n/a	n/a	• Oxytocin	n/a
Europe	Switzerland	n/a	Link	• Oxytocin or carbetocin	Vaginal and caesarean deliveries • Oxytocin, carbetocin or misoprostol
Europe	Turkey	n/a	n/a	• Oxytocin (40–60 IU IV infusion) • Methylergometrine (0.2 mg IM every 3–4 hours, 4–6 times) • Misoprostol tablets (1000 mcg rectally or 400–800 mcg sublingually)	Vaginal and caesarean deliveries • Oxytocin (5–10 IU IM or IV Infusion) • Methylergometrine (0.2 mg IM)
Europe	United Kingdom	2009	Link	• Syntocinon (5 IU slow IV bolus) • Ergometrine (0.5 mg slow IV or IM bolus) • Syntocinon (40 IU IV infusion in 500 mL Hartmann's solution at a rate of 125 mL/hour) • Carboprost (0.25 mg IM repeated at intervals of no less than 15 min). Maximum of 8 doses (2 mg) • Carboprost (0.5 mg intramyometrial injection) • Misoprostol (1000 mcg rectally)	Vaginal deliveries • Oxytocin (5 IU or 10 IU by IM) Caesarean deliveries • Oxytpocin (5 IU slow IV bolus) • Syntometrine (in the absence of hypertension) • Misoprostol (if oxytocin is not available, such as home-birth setting)
Latin America	Argentina	n/a	n/a	• Oxytocin (10/20 IU IM) • Ergometrine (0.2 mg IM) • Syntometrine • Misoprostol (400–600 mcg)	n/a
Latin America	Brazil	2010	n/a	1. Oxytocin (10 IU IM, 20–40 IU IV in 6 hours). Maintenance dose of 20 IU IV over 8 hours) 2. Ergometrine (0.2 mg IM). A second dose can be give after 15 min if required. Maintenance dose of 0.2 mg IM over 4 hours (total dosage should not exceed 1 mg) 3. Misoprostol (200–800 mcg sublingual). Do not exceed 800 mcg	Vaginal and caesarean deliveries 1. Oxytocin (10 IU IV or IM after delivery)
Latin America	Mexico	2010	Link	• Oxytocin (10–40 IU IV in 1000 mL saline) • Ergometrine (0.2 mg IM or IV) • Carbetocin (100 mcg single IV bolus) • Misoprostol (800 mg sublingually or rectally) • Tranexamic acid acid	Caesarean deliveries • Oxytocin (10–40 IU IV in 1000 mL saline) • Carbetocin 100 mcg/min IV can be used in elective caesarean section instead of oxytocin
Asia	China	2009	Link	• Oxytocin (10 IU IM, 5 IU IV or 10 IU IV infusion in 500 mL of liquid at a rate of 100–150 mL/hour)	Vaginal and caesarean deliveries 1. Oxytocin (10 IU IM, 5 IU IV or 10 IU IV infusion in 500 mL of liquid at a rate of 100–150 mL/hour) 2. Controlled cord traction, cord clamping and cutting 3. Uterine massage
Asia	Malaysia	n/a	n/a	1. Oxytocin (5 IU IV). Total of 40 IU infused over 24 hours	n/a
Asia	South Korea	n/a	n/a	n/a	Vaginal and caesarean deliveries • Oxytocin (5 IU slow IV infusion)
Asia	Thailand	2011	n/a	1. Oxytocin (10 IU IM, 5 IU IV or 10–20 IU IV infusion in 1000 mL saline at a rate of 100–150 mL/hour) 2. Methylergometrine	n/a
Asia	The Philippines	2014	n/a	1. Oxytocin IV 2. Carbetocin (100 mcg IM or IV over 1 min) or • Methylergometrine (0.2 mg IM every 2–4 hours). Maximum of 5 doses (1 mg) for 24-hour period or • Carboprost (0.25 mg IM every 15 min). Maximum of 8 doses (2 mg)	Vaginal and caesarean deliveries 1. Oxytocin (10 IU IM or 5 IU slow IV) 2. Carbetocin (100 mcg IM or IV over 1 min) or • Methylergometrine (0.2 mg IM every 2–4 hours). Maximum of 5 doses (1 mg) for 24-hour period
Asia	Vietnam	2012	n/a	1. Controlled cord traction 2. Carbetocin 100 mcg IM or IV in high-risk patient groups	Caesarean deliveries • Uterine massage • Oxytocin (5 IU IV infusion in 500 mL solvent). Maximum of 80 IU • Methylergometrine (0.2 mg IV or IM). Maximum of 5 doses (1 mg). Contraindicated for hypertension and Raynaud symptom • Carbetocin (100 mcg) • PGEF2α (250 mcg IM). Total dose 2 mg. Contraindicated for asthma and hypertension • PGE1 (800 mcg rectally)
Australasia	Australia	2012	Link	• Syntocinon, ergometrine or misoprostol (rectally)	Elective caesarean deliveries • Consider using carbetocin 100 mcg IV in 1 mL, given slowly over 1 min after birth of the baby Carbetocin is currently not indicated in emergency caesarean section or after vaginal birth
Australasia	New Zealand	2011	n/a	• Syntocinon, ergometrine, misoprostol (rectally) or prostaglandins	n/a
North America	Canada	2010	Link	1. Oxytocin (10 IU IM or 20–40 IU IV infusion at a rate of 500–1000 mL/hour) 2. Hemabate 3. Carbetocin (100 mcg IM or IV over 1 min) 4. Misoprostol (400–1000 mcg)	Caesarean deliveries • Carbetocin (100 mcg IV bolus over 1 min) Vaginal deliveries • Carbetocin (100 mcg IM)
North America	United States	2006	Link	1. Oxytocin (10 IU IM or 10–40 IU IV infusion in 1000 mL saline) 2. Methylergometrine (0.2 mg IM every 2–4 hours) 3. Hemabate (0.25 mg IM every 15–90 min). Maximum of 8 doses (2 mg) 4. Prostin (20 mg vaginally or rectally every 2 hours) 5. Cytotec (800–1000 mcg rectally)	Vaginal and caesarean deliveries 1. Oxytocin (10 IU IM or 10–40 IU IV infusion in 1000 mL saline) 2. Methylergometrine (0.2 mg IM every 2–4 hours) 3. Carboprost (Hemabate; 0.25 mg IM every 15–90 min). Maximum of 8 doses (2 mg) 4. Prostin (20 mg vaginally or rectally every 2 hours) 5. Cytotec (800–1000 mcg rectally)
Middle East	Israel	2013	n/a	• Oxytocin or prostaglandins	Vaginal and caesarean deliveries • Oxytocin or prostaglandins
Middle East	Lebanon	2012	n/a	1. Oxytocin	Vaginal and caesarean deliveries 1. Oxytocin (5–10 IU IV followed by continuous IV infusion of 20–30 IU) 2. Misoprostol (200 mcg) 3. Methylergometrine 4. Prostin
Middle East	Saudi Arabia	2013	Link	n/a	Use oxytocic drugs that can be given together or sequentially for vaginal and caesarean deliveries • Oxytocin (10 IU IM or 20 IU IV infusion in 1000 mL fluid at a rate of 60 drops/min) • Ergometrine (0.2 mg IM or slow IV). A second dose of 0.2 mg IM can be given after 15 minutes if required or a second dose of 0.2 mg slow IV given every 4 hours. Maximum of 5 doses (1 mg) • PGFα (0.25 mg IV given every 15 min). Maximum total dose of 2 mg
Africa	South Africa	n/a	n/a	n/a	Caesarean deliveries • Oxytocin (10 IU IV bolus, followed by a continuous infusion of 20–30 IU IV infusion) Vaginal deliveries • Oxytocin (10 IU IM)
Worldwide	World Health Organization	20112	Link	Pharmacological methods 1. Oxytocin IV 2. Ergometrine IV, syntometrine or prostaglandin (including misoprostol 800 mcg sublingual) 3. Tranexamic acid	Vaginal and caesarean deliveries 1. Oxytocin (10 IU IV or IM) 2. Ergometrine/methylergometrine, syntometrine or misoprostol (600 mcg orally)
Worldwide	International Federation of Gynecology and Obstetrics	2012	Link	• Oxytocin (10 IU IM, 5 IU slow IV bolus or 20–40 IU IV infusion) • Misoprostol (800 mcg sublingually) • Ergometrine/methylergometrine (0.2 mg IM). Repeat dose every 2–4 hours if required. Maximum total dose of 1 mg per 24-hour period • Syntometrine IM • Carbetocin (100 mcg IM or IV over 1 min) • Carboprost (0.25 mg every 15 min). Maximum of 8 doses (2 mg)	1. Oxytocin (10 IU IM or 5 IU slow IV bolus) 2. Ergometrine/methylergometrine (0.2 mg IM) 3. Misoprostol (600 mcg orally)

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