The new millennium sees the largest cohort of young people in history entering its fertile years. Many of these people are too poor to pay the full cost of modern contraception, but the money available for subsidizing their needs is exceedingly limited. The AIDS pandemic is placing additional, unprecedented demand on already overstretched resources. Existing methods of contraception that are well established and off-patent can be produced in bulk at low cost, and will remain the backbone of future programmes. The use of misoprostol as an abortifacient is likely to spread rapidly. New...
OBJECTIVE: To validate anecdotal reports that abortion-related complications decreased in the Dominican Republic after the introduction of misoprostol into the country.
DESIGN: Retrospective records reviews and cross-sectional surveys, interviews and focus groups.
SETTING: Family planning clinics, pharmacies, door-to-door canvassing and a tertiary care maternity hospital in Santo Domingo, Dominican Republic.
POPULATION: Women of reproductive age in Santo Domingo, Dominican Republic.
METHODS: Qualitative and quantitative methods were used. Individual interviews...
This commentary article refers to the meeting of theInternational Federation of Gynecology and Obstetrics (FIGO) in Santiago, Chile in 2003, which made reducing post-partum hemorrhage a priority, and two meetings supported by Venture Strategies in May and July 2004 in Kampala, Uganda and Nairobi, Kenya, which took the first steps toward meeting that goal.
This groundbreaking pilot study demonstrates the potential impact of misoprostol for women in rural settings. In this community-based intervention trial, misoprostol was delivered by traditional birth attendants (TBAs) for PPH treatment in rural Kigoma, Tanzania. Results show that TBAs successfully administered misoprostol. Women given misoprostol to treat PPH were far less likely to need additional intervention.
OBJECTIVES: Determine safety of household management of postpartum hemorrhage (PPH) with 1000 microg of rectal misoprostol, and assess possible reduction in referrals and...
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, 184-190...
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.
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...
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.
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...