The development of oxytocic drugs in the management of postpartum haemorrhage

Throughout history obstetric haemorrhage has been a major cause of maternal mortality in both developed and developing countries.1' 2The oldest work in obstetrics and gynaecology, published toward the end ofthe first century AD, is attributed to Soranus of Ephesus, who brought together the knowledge of obstetrics, gynaecology and paediatrics of that era.3 Soranus gives no account of oxytocic medications but does give some sensible advice on the general management of hyopvolaemic shock associated with postpartum haemorrhage, advising that the woman should 'lie down in a relatively small, dark and moderately cool room upon a hard bed ... raised a little at the foot'. He also described what could be regarded as the forerunner of the Medical Antishock Trousers (MAST): 'and the extremities should be gripped tightly and bandaged, for the compression resulting from this squeezing is transmitted all the way to the affected part'.'