Prevention of Postpartum Hemorrhage
Misoprostol
In rural, low resource settings, where the majority of deliveries take place at home without a skilled birth attendant, women risk serious complications or even death from PPH due to limited access to emergency obstetric services. In order to determine the impact of postpartum administration of misoprostol on PPH in home birth settings where access to oxytocin is limited, the Aga Khan University-Karachi, Aga Khan Health Services-Pakistan & France, and Gynuity Health Projects-New York jointly conducted a community-based study in Pakistan’s North-West Frontier Province. This study tested whether 600mcg oral misoprostol reduces the incidence of PPH when administered by traditional birth attendants during the third stage of labor following home births.
The results of this trial demonstrated that oral misoprostol reduced the rate of PPH (>500ml) by 24% compared with placebo. Women receiving misoprostol had a smaller drop in hemoglobin (>2g/dL) from pre- to post-delivery, compared with placebo. Based on the results of this and previous community-based studies, oral misoprostol (600mcg) is safe and effective, and could be used routinely for PPH prevention in low-resource settings where injectable oxytocin is not available or not feasible. Misoprostol is easy to use and administer, and traditional birth attendants can be trained in its appropriate use for prevention of PPH. Careful monitoring and evaluation should accompany any widespread introduction of this drug.
Misoprostol Used in Combination with Other Medications
Adjunct use of misoprostol after childbirth has entered into clinical practice without evidence to support a specific regimen. To demonstrate the value-added of using misoprostol in conjunction with injectable uterotonics, Gynuity collaborated on a research trial with the Effective Care Research Unit, East London, South Africa and providers at hospitals in South Africa, Nigeria, and Uganda to test whether 400mcg sublingual misoprostol, in addition to routine oxytocin during the third stage of labor, has a greater effect in preventing PPH than oxytocin alone. The results of this trial are forthcoming.