# Uterotonic Drugs in Prevention and Management in Postpartum Haemorrhage in Prehospital Deliveries—A Systematic Review

## TL;DR

This review examines how uterotonic drugs like oxytocin can help prevent and manage postpartum haemorrhage during prehospital births, highlighting gaps in evidence and the need for better guidelines.

## Contribution

The study identifies a lack of high-quality evidence on uterotonic drugs in prehospital EMS and emphasizes the need for targeted research to improve maternal outcomes.

## Key findings

- Only four studies met the inclusion criteria, indicating limited evidence on uterotonic drugs in prehospital settings.
- Oxytocin is the only uterotonic drug available in some EMS teams, while others have none.
- EMS plays a critical role in managing PPH but lacks robust clinical evidence to guide interventions.

## Abstract

Background: Obstetric haemorrhage, particularly postpartum haemorrhage (PPH), remains a significant global health challenge and a leading cause of maternal mortality. Despite advancements in understanding and preventing PPH, haemorrhage remains a leading cause of maternal mortality worldwide. The aim of this study was to review the current literature on the use of uterotonic drugs, particularly oxytocin, in reducing perinatal mortality during prehospital deliveries. Methods: In December 2024, a comprehensive search was conducted across PubMed, Web of Science, Embase, and Scopus, yielding 108 records, of which four studies met the inclusion criteria. Results: The limited evidence underscores the need for targeted research and adherence to international obstetric guidelines to improve PPH management and maternal outcomes. In some countries, the only uterotonic drug available in all EMS teams is oxytocin; in others, there is none. Emergency Medical Services (EMS) play a critical role in providing lifesaving interventions during obstetric emergencies, often serving as the first and sometimes only point of medical contact for women experiencing complications during childbirth. Conclusion: There is a lack of high-quality clinical studies evaluating the effectiveness of uterotonic agents in EMS operations and their role in treating postpartum haemorrhage in prehospital settings. Addressing this gap requires targeted research to generate robust evidence and inform the development of standardized protocols. Such efforts could enhance the timely management of PPH, ultimately reducing maternal mortality and improving outcomes in resource-limited and prehospital environments. By bridging the evidence gap, EMS systems worldwide can be better equipped to handle obstetric emergencies effectively.