Should oral misoprostol be used to prevent postpartum haemorrhage in home birth settings in low resource countries? A systematic review of the evidence.
Authors: Hundley, V., Avan, B., Sullivan, C. and Graham, W.
Conference: Global Women's (GLOW) Research Conference
Dates: 1 November 2012Abstract:
Background: Using misoprostol to prevent postpartum haemorrhage (PPH) in home birth settings remains controversial.
Objective: To review the safety and effectiveness of oral misoprostol in preventing PPH in home birth settings.
Search Strategy: the Cochrane Library, PubMed, and POPLINE were searched for articles published until 31 March 2012.
Selection criteria: Studies, conducted in low resource countries, comparing oral misoprostol to a placebo or no treatment in a home birth setting. Studies of misoprostol administered by other routes were excluded.
Data collection and analysis: Data were extracted by two reviewers and independently checked for accuracy by a third. Quality of evidence was assessed using GRADE criteria. Data were sythesised and meta-analysis performed where appropriate.
Main results: Ten papers were identified, describing two randomised and four non-randomised trials. Administration of misoprostol was associated with a significant reduction in the incidence of PPH (RR = 0.58, 95% CI: 0.38 to 0.87), additional uterotonics (RR = 0.34, 95% CI: 0.16 to 0.73) and referral for PPH (RR = 0.49, 95% CI: 0.37 to 0.66). None of the studies was large enough to detect a difference in maternal mortality and none reported neonatal mortality. Shivering and pyrexia were the most common side effects.
Conclusions: The finding that misoprostol is effective in preventing PPH has the potential to translate into many lives saved. However, adverse effects have not been systematically captured, and there has been limited consideration of the potential for inappropriate or inadvertent use of misoprostol.
Preferred by: Vanora Hundley