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

Raghavan, Sheila; Geller, Stacie E.; Miller, Suellen; Goudar, Shivaprasad S.; Anger, H; Yadavannavar, M. C.; Dabash, Rasha; Bidri, SR; Gudadinni, M R; Udgiri, Rekha; Koch, AR; Bellad, Mrutyunjaya; Winikoff, Beverly

doi:10.1111/1471-0528.13540

Cited by 33 publications

(44 citation statements)

References 21 publications

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“…These findings suggest that reliance on referral to higher levels of care is insufficient for managing PPH. Because some women will experience PPH after prophylaxis, programs should focus more on treatment or “early treatment” models …”

Section: Discussionmentioning

confidence: 99%

“…Because some women will experience PPH after prophylaxis, programs should focus more on treatment or "early treatment" models. 23 To our knowledge, no other studies have examined use of misoprostol for PPH prevention and treatment in the same delivery. In the present trial, use of misoprostol (800 μg sublingual) for treatment after it was used for prevention (600 mcg oral) did not result in adverse events or serious adverse effects.…”

Section: Discussionmentioning

confidence: 99%

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Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

Abbas

Jehan²,

Diop

et al. 2019

Intl J Gynecology & Obste

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Objective To explore the clinical and programmatic feasibility of using 800 μg of sublingual misoprostol to prevent and treat postpartum hemorrhage (PPH) during home delivery. Methods The present double‐blind randomized controlled trial included women who underwent home deliveries in Chitral district, Khyber Pakhtunkhwa province, Pakistan, after presenting at healthcare facilities during the third trimester of pregnancy between May 28, 2012, and November 27, 2014. Participants were randomized in a 1:1 ratio to receive either 800 μg of misoprostol or placebo sublingually if PPH was diagnosed, having previously received a prophylactic oral dose of 600 μg misoprostol. The primary outcome, hemoglobin decrease of 20 g/L or greater from pre‐ to post‐delivery assessment, was compared on a modified intention‐to‐treat basis. Results There were 49 patients allocated to receive misoprostol and 38 allocated to receive placebo; the incidence of a 20 g/L decrease in hemoglobin was similar between the groups (20/43 [47%] vs 19/33 [58%], respectively; P=0.335). Conclusion There was no significant difference in clinical outcomes between the two trial arms. ClinicalTrials.gov:NCT01485562.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

Abbas

Jehan²,

Diop

et al. 2019

Intl J Gynecology & Obste

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“…Secondary prevention is a community‐based strategy that has been shown to be a comparable alternative to a universal prophylaxis approach in two large community trials (one in press) . Rather than medicating all women during the third stage of labor with a prophylactic dose, a regimen of 800 μg sublingual misoprostol (the same as for treatment) can be used to treat only women with higher‐than‐average bleeding (e.g.…”

Section: Secondary Prevention Of Postpartum Hemorrhage For Community‐mentioning

confidence: 99%

“…In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. In light of new evidence and through expert deliberation, this chart has now been revised and expanded (Fig. ).…”

Section: Introductionmentioning

confidence: 99%

FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics

Morris

Winikoff

Dabash

et al. 2017

Intl J Gynecology & Obste

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In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. In light of new evidence 1-13 and through expert deliberation, this chart has now been revised and expanded (Fig. 1). Some areas were particularly challenging to develop given the limited, low-quality, or inconsistent evidence. The present commentary is intended to explain some of the changes and decisions made. | GENERAL CHANGESThe layout is now categorized vertically by gestation and horizontally by indication. Gestation is labelled and referred to as the number of weeks of gestation (<13 weeks, 13-26 weeks, and >26 weeks), with the final column being for postpartum use. However, in the case of incomplete abortion under 13 weeks, and inevitable abortion between 13-26 weeks, women should be treated on the basis of their uterine size rather than last menstrual period dating. Recommendations have been added for inevitable abortion and cervical preparation between 13 and 26 weeks, and for termination of pregnancy at more than 26 weeks. | NUMBER OF DOSESFor less than 13 weeks' gestation, we decided to recommend a fixed number of doses without specifying a maximum. This is because many early pregnancy regimens will be used on an outpatient basis, so it is useful for healthcare providers to know in advance how many doses to give the client; there is also sufficient evidence to support a fixed number of doses for use in pregnancies of less than 13 weeks' gestation, as well as evidence that it is safe to give further doses if they are required. [1][2][3][4]14 For 13-26 weeks' gestation, the notion of a maximum number of doses has been extrapolated from clinical research in which maximum doses are commonly noted not on the basis of patient safety issues or efficacy, 9 but rather as tangible endpoints. In clinical practice, however, they might not have great utility, and dosing should continue until expulsion, in the absence of rare complications. Suggesting that providers should discontinue dosing could actually increase risks, particularly when providers have few alternatives available if expulsion has not yet This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Raghavan et al, [10] a rm that routine uterotonic prophylaxis, such as, the use of Oxytocin, the gold standard uterotonic medication for PPH prevention, is not 100% effective in preventing PPH. Therefore, WHO [7] is urging international agencies and donors, as well as professional associations, clinicians and national health system stakeholders to reassess their national health policies and protocols on PPH prevention.…”

Section: Introductionmentioning

confidence: 99%

Influencing Factors for Early Detection and Prevention of Postpartum Hemorrhage in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives.

Bazirete

Nzayirambaho

Umubyeyi

et al. 2020

Preprint

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Background: Reduction of maternal mortality and morbidity is a major global health priority.However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for early detection and prevention of PPH as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory‐mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives, community health workers (CHWs) in charge of maternal health and health care providers . A socio ecological model was used to develop interview guides to describe factors related to early detection and prevention of PPH in consideration of individual attributes, interpersonal, family and peer influences, intermediary determinants of health and structural determinants. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: We generated four interrelated themes:Meaning of PPH: beliefs, knowledge and understanding of PPH:Organizational factors; Caring and family involvement and Perceived risk factors and barriers to PPH prevention. The findings from this study indicate that PPH was poorly understood by women and their partners. Family members and CHWs feel that their role for the prevention of PPH is to get the woman to the health facility on time. The main factors associated with PPH as described by participants were multiparty and retained placenta. Low socioeconomic status and delays to access health care were identified as the main barriers for the prevention of PPH. Conclusions: Addressing the identified factors could enhance early prevention of PPH among childbearing women. Placing emphasis on developing strategies for early detection of women at higher risk of developing PPH, continuous professional development of health care providers, developing educational materials for CHWs and family members could improve the prevention of PPH. A further case control study is warranted to develop a screening tool for early detection predictors to PPH.

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

Cited by 33 publications

References 21 publications

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics

Influencing Factors for Early Detection and Prevention of Postpartum Hemorrhage in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives.

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