Universal oxytocin prophylaxis is rock-sculpted? Atony is one cause, but not the main cause of postpartum hemorrhage

The WOMAN Trial found that tranexamic acid (TXA) reduces mortality due to bleeding in women with postpartum hemorrhage (PPH) after cesarean and vaginal births, with no adverse effects and no increase in thromboembolic events incidence. On the other hand, the network meta-analysis of 196 randomized trials showed that all uterotonic agents are effective in preventing PPH ≥ 500 mL compared to placebo or no treatment at all. This meta-analysis also demonstrated that all agents, except for ergometrine and injectable prostaglandins, are effective in preventing PPH ≥ 1,000 mL compared to placebo or no treatment at all. But equally important is that no differences were observed in terms of maternal death, severe maternal morbidity, and Intensive Care Unit admissions. This review tries to explain why, although prophylactic administration of uterotonics is able to reduce the amount of blood lost by women at childbirth, it is generally unable to save women’s lives. The hope is that awareness of this evidence will lead to new lines of research and to a better understanding of the problem.