Jill Durocher

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

September 1st, 2015
Raghavan, S., Geller, S., Miller, S., Goudar, S.S., Anger, H., Yadavannavar, M.C., Dabash, R., Bidri, S.R., Gudadinni, M.R., Udgiri, R., Koch, A.R., Bellad, M.B., Winikoff, B.

BJOG; 2016 Jan; 123(1):120-7; doi:10.1111/1471-0528.13540

The article describes a community trial implemented by a team from India and the USA that compared two approaches to the management of postpartum hemorrhage – the leading complication of childbirth that causes approximately a quarter of all maternal deaths each year. The study compared the current standard, ‘universal prophylaxis’ --a commonly-advocated community approach for reducing postpartum hemorrhage whereby every woman is administered a preventive uterotonic medicine to contract the uterus-- to a novel approach, ‘secondary prevention/early treatment’ -- where only the small proportion of women who bleed more than average are offered a treatment dose of misoprostol. Results show that the secondary prevention approach medicated substantially fewer women (4.7% versus 99.7%), who experienced significantly fewer side effects. There were no statistical differences in post-delivery hemoglobin levels, rate of postpartum hemorrhage, and rate of transfer to higher level facilities. The authors conclude that this new research shows secondary prevention/early treatment to be a feasible non-inferior alternative strategy to universally medicating all women who deliver with prophylaxis. The approach has the potential for being more acceptable, cost-effective and sustainable, with the additional potential to equip community-level providers with a timely strategy to manage bleeding before it reaches the point of an emergency.