Clinical recommendation	Evidence rating	References
Active management of the third stage of labor decreases postpartum blood loss and the risk of postpartum hemorrhage (number needed to treat=12).	A	2,17
Active management of the third stage of labor does not increase the risk of retained placenta.	A	2,17,18
Oxytocin (Pitocin) is the first choice for prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has fewer side effects.	A	2,25,26
Misoprostol (Cytotec) may be used when other oxytocic agents are not available for prevention of postpartum hemorrhage (number needed to treat=18).	A	27
Misoprostol may be used for treatment of postpartum hemorrhage, but this agent is associated with more side effects than conventional uterotonic drugs.	A	37
Routine episiotomy increases anal sphincter tears and blood loss.	A	11,40