Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage

Chu, Christina; Brhlíková, Petra; Pollock, Allyson M

doi:10.1258/jrsm.2012.120044

Cited by 35 publications

(25 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even after the WHO’s decision to support misoprostol use for PPH prevention at home births, there have been continued opponents of misoprostol use for this purpose, claiming insufficient evidence [43]. Other researchers pooled existing study data to determine the potential impact of misoprostol on PPH mortality and found that its use neither increased nor decreased mortality or severe morbidity [44].…”

Section: Resultsmentioning

confidence: 99%

Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Prata¹,

Bell²,

Quaiyum

2014

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundBangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.MethodsUsing data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.ResultsUsing project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.ConclusionThis theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.

show abstract

Section: Resultsmentioning

confidence: 99%

Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Prata¹,

Bell²,

Quaiyum

2014

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…This body of evidence led the World Health Organization (WHO) to amend its model list of essential medicines in March 2011 to include misoprostol for the prevention of PPH in settings “where oxytocin is not available or cannot be safely used” [20], although some have expressed concern about this decision [21]. …”

Section: Introductionmentioning

confidence: 99%

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

Smith

Gubin²,

Holston³

et al. 2013

BMC Pregnancy Childbirth

103

View full text Add to dashboard Cite

BackgroundHemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births.MethodsWe conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events.ResultsEighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these countries.ConclusionsCommunity-based programs for prevention of PPH at home birth using misoprostol can achieve high distribution and use of the medication, using diverse program strategies. Coverage was greatest when misoprostol was distributed by community health agents at home visits. Programs appear to be safe, with an extremely low rate of ante- or intrapartum administration of the medication.

show abstract

“…55-57 This is the first study that has systematically evaluated the use of misoprostol for reducing intraoperative and postoperative blood loss in women undergoing cesarean delivery. The pooled evidence in our systematic review shows that, overall, the combined use of misoprostol and oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage at cesarean delivery.…”

Section: Commentmentioning

confidence: 99%

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

Conde-Agudelo

Díaz

Rosas-Bermúdez

et al. 2013

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol versus oxytocin and 8 evaluated misoprostol plus oxytocin versus oxytocin. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, −2.1%; 95% confidence interval [CI], −3.4 to −0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% CI, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during caesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.

show abstract

Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage

Cited by 35 publications

References 23 publications

Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

Contact Info

Product

Resources

About