Maternal Health

The safety of misoprostol

Anke Hemmerling
2006

Misoprostol is currently on the WHO Essential Drug List for treatment of gastric ulcers, for induced abortion in combination with mifepristone, and more recently for induction of labor. The WHO will review its role as an essential drug for control of postpartum hemorrhage (PPH) in early 2007. Relevant data on the safety of misoprostol has accumulated since the introduction of the drug in the late 1980s. Since then, millions of individuals worldwide have used up to four tablets (800 mcg) daily for treatment and prevention of gastric ulcer.

Published in International Journal of...

Tackling the unacceptable: Nigeria approves misoprostol for postpartum haemorrhage

Amy Jadesimi
Friday E Okonofua
2006

This article discusses the approval of misoprostol in Nigeria for the prevention of postpartum hemorrhage in 2006.

Nigeria has 2% of the world’s population, but 10% of the global burden of maternal deaths – a statistic that is described by Nigeria’s president Olusegun Obasanjo as “unacceptable and must be reversed”. In January 2006, Nigeria took an important step towards reversing this tragic situation when the Nigerian National Agency for Food and Drug Administration and Control approved the distribution of misoprostol for the prevention or treatment of postpartum haemorrhage (PPH...

Using the kanga to measure postpartum blood loss

N Prata
G Mbaruku
M Campbell
2005

In rural African settings, the colorful fabric kanga is locally-made and inexpensive; every woman owns dozens for use as skirts and shawls. The kanga has become useful as a simple solution for the complicated problem of measuring blood loss after delivery. This commentary describes remarkable results when traditional birth attendants in Tanzania use the kanga to identify postpartum hemorrhage.

Published in International Journal of Gynecology and Obstetrics (2005) 89, 49—50

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A Textbook of Postpartum Hemorrhage: Chapter 17: Management of Postpartum Hemorrhage at the Community Level

Ndola Prata
2006

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 ability to manage postpartum...

Global availability of misoprostol

M Campbell
M Holden
2006

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

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Parachute approach to evidence based medicine

M Potts
N Prata
J Walsh
A Grossman
2006

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...

The worldwide burden of postpartum haemorrhage: Policy development where inaction is lethal

Malcolm Potts
Anke Hemmerling
2006

This article evaluates the burden of Postpartum hemorrhage, the single most common cause of maternal death and calls for bold new policies.

Abstract: Most maternal deaths occur to women who are not attended by trained health professionals. Postpartum hemorrhage is the single most common cause of maternal death. The delivery of large haemochorial placenta in our species predisposes to heavy bleeding and can be dealt with only by using effective uterotonics. The 1987 Safe Motherhood Initiative has failed to reduce maternal mortality significantly, and shortages of trained personnel...

A global overview of ongoing misoprostol studies

Ndola Prata
2006

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...

Misoprostol and active management of the third stage of labor

N Prata
S Hamza
R Gypson
K Nada
F Vahidnia
M Potts
2006

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...

Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings

S Bradley
N Prata
N Young-Lin
D Bishai
2007

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.

Result: The misoprostol strategy...