Misoprostol in the management of the third stage of labour in the home delivery in Gambia
- September 1st, 2005
- Postpartum Hemorrhage
- Winikoff, Beverly, Blum, Jennifer, Walraven, G., Dampha, Y., Sowe, M., Morison, L., Sloan, N.
BJOG; 2005 Sep; 112(9):1277-83; doi:10.1111/j.1471-0528.2005.00711.x
Objective: To assess the effectiveness of 600 microg oral misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low income country home birth situation.
Design: Double blind randomised controlled trial.
Setting: Twenty-six villages in rural Gambia with 52 traditional birth attendants (TBAs).
Sample: One thousand, two hundred and twenty-nine women delivering at home under the guidance of a trained TBA.
Methods: Active management of the third stage of labour using three 200-microg misoprostol tablets and placebo or four 0.5-mg ergometrine tablets (standard treatment) and placebo. Tablets were taken orally immediately after delivery.
Main outcome measures: Measured blood loss, postpartum haemoglobin (Hb), difference between Hb at the last antenatal care visit and three to five days postpartum.
Results: The misoprostol group experienced lower incidence of measured blood loss > or =500 mL and postpartum Hb <8 g/dL, but the differences were not statistically significant. The reduction in postpartum (compared with pre-delivery) Hb > or = 2 g/dL was 16.4% with misoprostol and 21.2% with ergometrine [relative risk 0.77; 95% confidence interval (CI) 0.60-0.98; P= 0.02]. Shivering was significantly more common with misoprostol, while vomiting was more common with ergometrine. Only transient side effects were observed.
Conclusions: Six hundred micrograms of oral misoprostol is a promising drug to prevent life-threatening PPH in this setting.