Ans- C Ref- Recommendations for PPH treatment The use of uterotonics (oxytocin alone as the first choice) plays a central role in the treatment of PPH (see Boxes 4and 5). Uterine massage is recommended for the treatment of PPH as soon as it is diagnosed (see Box 6) and the initial fluid resuscitation with isotonic crystalloids is recommended. The use of tranexamic acid is advised in cases of refractory atonic bleeding or persistent trauma-related bleeding (see Box 5). The use of intrauterine balloon tamponade is recommended for refractory bleeding or if uterotonics are unavailable. Bimanual uterine compression, external aortic compression, and the use of non-pneumatic anti-shock garments are recommended as temporizing measures until substantive care is available. If there is persistent bleeding and the relevant resources are available, uterine artery embolization should be considered. If bleeding persists despite treatment with uterotonic drugs and other conservative interventions, surgical intervention should be used without further delay. Box 4 Recommendations for the treatment of PPH - uterotonics. Intravenous oxytocin is the recommended uterotonic drug for the treatment of PPH. (Strong recommendation, moderate quality evidence) If intravenous oxytocin is unavailable, or if the bleeding does (more...) Box 5 Recommendations for the treatment of PPH - fluid resuscitation and tranexamic acid. The use of isotonic crystalloids is recommended in preference to the use of colloids for the intravenous fluid resuscitation of women with PPH. (Strong recommendation, (more...) Box 6 Recommendations for the treatment of PPH - manoeuvres and other procedures. Uterine massage is recommended for the treatment of PPH. (Strong recommendation, very-low-quality evidence) If women do not respond to treatment using uterotonics, or if uterotonics (more...) If the third stage of labour lasts more than 30 minutes, CCT and IV/IM oxytocin (10 IU) should be used to manage the retained placenta. If the placenta is retained and bleeding occurs, the manual removal of the placenta should be expedited. Whenever the manual removal of the placenta is undertaken, a single dose of prophylactic antibiotics is recommended (see Box 7). Box 7 Recommendations for the treatment of retained placenta. If the placenta is not expelled spontaneously, the use of additional oxytocin (10 IU, IV/IM) in combination with controlled cord traction is recommended. (Weak recommendation, very-low-quality evidence) (more...) The GDG also issued recommendations related to the organization of PPH care (see Box 8). Health facilities delivering maternity services should adopt formal protocols for the prevention and treatment of PPH and for patient referral. The use of PPH treatment simulations for pre-service and in-service training programmes was recommended. Finally, the GDG recommended that the use of uterotonics for the prevention of PPH should be monitored and a specific indicator was suggested. Box 8 Health Systems and Organization of Care recommendations for the prevention and treatment of PPH. The use of formal protocols by health facilities for the prevention and treatment of PPH is recommended. (Weak recommendation, moderate-quality evidence) (more...) The GDG found insufficient evidence to recommend one route over another for the prevention of PPH with oxytocin, the use of recombinant factor VIIa for the treatment of PPH, intraumbilical vein injection of oxytocin for treatment of retained placenta, and the antenatal distribution of misoprostol. The GDG also found insufficient evidence to recommend self-administration for the prevention of PPH and the measurement of blood loss over clinical estimation (see Box 9). Box 9 Statements related to topics for which there is insufficient evidence to issue a recommendation. There is insufficient evidence to recommend one oxytocin route over another for the prevention of PPH. There is insufficient evidence to recommend the use (more...) Copyright (c) 2012, World Health Organization. All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw). Requests for permission to reproduce or translate WHO publications - whether for sale or for noncommercial distribution - should be addressed to WHO Press through the WHO web site (