Objective To investigate the use of the oral prostaglandin E, analogue, misoprostol in the prevention of Design A prospective observational study.Setting A university teaching hospital. Participants Two hundred and thirty-seven consecutive women undergoing vaginal delivery.Methods All the women were given 600 pg oral misoprostol just after delivery.

Objective To compare misoprostol with standard oxytocic regimens in the prevention of postpartum Design Randomised controlled trial.Setting Obstetric unit in a large teaching hospital.Methods One thousand women randomised to 500 pg misoprostol given orally or to standard oxytocic regimens of oxytocin, oxytocin with ergometrine, or ergometrine. Main outcome measuresIncidence of postpartum haemorrhage and the incidence and severity of side effects.Results Postpartum haemorrhage occurred in 12% of women given misoprostol and in 11% of women given standard oxytocic drugs (relative risk (RR) 1.10, 95% confidence interval (CI) 0.79, 1.55). Blood loss of 1000 mL or more occurred in 2% of women in each group. Nausea, headache, dizziness and tiredness were less frequent with misoprostol (RR (95% CI) 0.71 (0.59,0434); 0.53 (0.38,0.74); 0.73 (0.61,0.87) and 0.88 (0.83, 0.94) respectively). The main side effects of misoprostol were shivering (RR 1.95,95% CI 1-69,2.25) and a rise in temperature (difference in mean rise 0-34OC, 95% CI ConclusionOral misoprostol for the prevention of postpartum haemorrhage was comparable to standard oxytocics. Many side effects were less common with misoprostol but shivering and pyrexia were more common. Larger randomised trials are needed before establishing the equivalence between misoprostol and standard oxytocic drugs in the prevention of postpartum haemorrhage.haemorrhage. 0*26,0*42).

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This article provides an account of maternity services in a university hospital in the USA, covering pregnancy, labour and delivery and follow-up care. Obstetricians are the main care providers, although midwifery care is also available. Obstetric nurses give labour and postnatal support. Although this is not an account of the differences between the UK and the described USA system, the most obvious differences are highlighted, these being the variety of practice and the numbers of personnel involved at the delivery. Resources available to both staff and users of the service are substantial, and if midwives are contemplating gaining experience overseas the author highly recommends working within the USA health system.