The physiology and management of the third stage of labouras well as etiology and management of primary PPH werereviewed in detail in the first part of this work. This reviewshould that in addition to the above general communitymeasures and active management of labour, the use ofuterotonics drugs in crucial to reduce the incidence of primaryPPH. The time-honored uterotonic drugs: pitocin andergometrine or both in combination are still the first line ofdefense against primary PPH in the hospital setting.Misoprostol, aPGE1 analog, was discovered accidentally inthe 1980`s to be effective in causing uterine contractions. Sincethat time, this drug has undergone extensive study for variousindications, one of the most important being the prevention ofPPH.