Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Sustained uterine massage is not recommended as an intervention to prevent postpartum haemorrhage (PPH) in women who have received prophylactic oxytocin
Not recommended
Notes and Remarks
- Sustained uterine massage refers to the continuous, repetitive manual stimulation of the uterine fundus after birth to encourage uterine contraction.
- There is a lack of evidence regarding the role of uterine massage for PPH prevention when no uterotonic drugs are used, or if a uterotonic drug other than oxytocin is used (e.g. carbetocin or misoprostol). In such cases, close and ongoing monitoring of uterine tone and the woman’s overall clinical status is essential, and any decision to perform uterine massage should be guided by clinical judgement rather than applied routinely.
- Although the GDG acknowledged that one small study reported that sustained uterine massage and clot expulsion were associated with a reduction in the use of additional uterotonics, there is lack of robust evidence supporting other benefits. However, the GDG considered that routine and frequent uterine tone assessment remains a crucial part of immediate postpartum care, particularly for the optimization of early PPH diagnosis.
- Intermittent uterine tone assessment (e.g. periodic palpation) remains important as part of routine postpartum monitoring to detect uterine atony and guide further action if needed