Misoprostol is registered as a gastric ulcer drug in many middle to high income countries; it is also used ‘off label’ in these same countries to prevent and control PPH. Its ease of administration and stability in tropical climates make it an ideal drug for use in home births, as well as with Active Management of the Third Stage of Labor (AMTSL) in any busy hospital.
Published in International Journal of Gynecology and Obstetrics, 94 (2) 2006, 151-152
Waiting for the results of randomised trials of public health interventions can cost hundreds of lives, especially in poor countries with great need and potential to benefit. If the science is good, we should act before the trials are done. Good science, we suggest, is taking the research to the problem rather than conducting the research in the tallest ivory tower the investigator can find. Randomised controlled trials are needed and, when appropriate, should be part of the empirical evidence necessary for decision making. The question is how much evidence is needed to move from research...
Clinical research has the potential to advance knowledge in the use of a technology and to help inform the decision-making process involving the public health benefits of such technology. In the last decade, one of the most important advances in maternal health, with special significance for developing countries, was the research on the gynecological indications of the use of misoprostol. Numerous studies have shown misoprostol’ s efficacy in the management of postpartum hemorrhage (PPH), pregnancy termination, labor induction, and cervical ripening. Its multiple non-parenteral routes of...
Objective: To compare current practices for the active management of the third stage of labor (AMTSL) with the use of 600 Ag of oral misoprostol. Methods: An operations research study was designed to compare blood loss with current AMTSL practices and misoprostol use. Results: Women in the misoprostol group were less likely to bleed 500 ml or more (adjusted odds ratio, 0.30; 95% confidence interval, 0.16—0.56) compared with those in the current practices group. In the current practices group 73% women required interventions because of postpartum hemorrhage, compared with 11% in the...
Objective: To test the cost-effectiveness of training traditional birth attendants (TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal dose of misoprostol in areas with low access to modern delivery facilities.
Method: A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000 women each giving birth with TBAs: one under standard treatment (TBA referral to hospital after blood loss ≥ 500 ml), and one attended by TBAs trained to recognize PPH and to administer 1000 μg of misoprostol at blood loss ≥ 500 ml.
The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemmorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.
Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 18,4-190...
Chapter 16 in A Textbook of Postpartum Hemorrhage discussing Misoprostol in Practice
“As a low-cost, easy-to-administer, powerful uterotonic with an excellent safety profile and long shelf-life, misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage in precisely those situations where it is most common – delivery at home without a skilled birth attendant.”
Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 178-179
Chapter 17 in A Textbook of Postpartum Hemorrhage discussing Management of Postpartum Hemorrhage at the Community Level
The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.
The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion...
This comment in the explores the role of policy and research in using the prevention of postpartum hemorrhage and suggest a joint meeting by WHO and FIGO to revisit the 2009 statement by WHO which does not recommend the use of misoprostol at the community level.
