High Fever Incidence Following Treatment with Misoprostol for Postpartum Hemorrhage (PPH)

Two large multi-country trials assessing oxytocin (40 IU IV) and misoprostol (800 mcg sublingual) found both regimens stopped active bleeding within 20 minutes of administration in nine out of 10 women with PPH. Reports of fever and shivering were common among women treated with misoprostol; however, overall acceptability of the medicine was high.

An unexpected finding from these studies was the significant variability in the rates of shivering and fever across sites. This document summarizes additional research -- prompted by the finding from one site in Quito, Ecuador where women were especially prone to experiencing elevated temperature ≥40.0°C (≥104°F) after use of misoprostol – to:

(1) explore whether a thermoregulatory response to misoprostol is based on genetic factors, and

(2) characterize the occurrence of high fever in other settings.