Study training to assess fever after misoprostol administration for the treatment of PPH

In January, Gynuity staff held a training for doctors and nurses at the Hospital Gineco-Obstetrico Isidro Ayora in Quito, Ecuador who will carry out a study to investigate whether a regimen of 600 mcg sublingual misoprostol will reduce the occurrence of side effects when used to treat primary postpartum hemorrhage (PPH). This information is especially important for places where high fevers (≥40.0° Celsius) are common following postpartum administration of misoprostol. At the hospital in Quito, a higher-than-expected rate of fever was previously documented in which over one-third of all women receiving misoprostol treatment (800 mcg sublingually) experienced high fever, compared with 0–10% in eight other hospitals following the same treatment protocol.

In an effort to better understand the relationship between misoprostol dose and occurrence of fever, we will conduct a pilot study to test a lower dose of sublingual misoprostol and collect information on side effects experienced among 75 women treated with misoprostol for PPH. An additional aim of the study will be to investigate the possible genetic factors associated with misoprostol-induced fever. Genetic analyses will be conducted at the University of Liverpool, Department of Pharmacology. This trial is the first phase of a series of investigations that will study the potential of lower doses of sublingual misoprostol for treatment of PPH.