Comment: The quality of evidence is downgraded by study limitations (lack of blinding in over half of the studies).
A Cochrane review [Abstract] 1 included 72 studies with a total of 52 678 subjects. Prostaglandins have mainly been used for postpartum haemorrhage (PPH) when other measures fail or are not available. Oral or sublingual misoprostol compared with placebo is effective in reducing severe (over 1000ml) PPH (oral: 7 trials, n=6225, not totalled due to significant heterogeneity; sublingual: RR 0.66, 95% CI 0.45 to 0.98; one trial, n=661) and blood transfusion (oral: RR 0.31, 95% CI 0.10 to 0.94; 4 trials, n=3519). Compared with conventional injectable uterotonics, oral misoprostol was associated with higher risk of severe PPH (RR 1.33, 95% CI 1.16 to 1.52; 17 trials, n=29 797) and use of additional uterotonics, but with a trend to fewer blood transfusions (RR 0.84, 95% CI 0.66 to 1.06; 15 trials, n=28 213). Misoprostol use is associated with significant increases in shivering and a temperature of 38º Celsius compared with both placebo and other uterotonics.
Another Cochrane review [Abstract] 2included 78 studies with a total of 59 216 subjects. There was no statistically significant difference in maternal mortality for misoprostol compared with control groups overall (11/19 715 versus 4/20 076 deaths; RR 2.08, 95% CI 0.82 to 5.28; 31 trials), or for misoprostol versus placebo (6/4 626 versus 1/4 707 ; RR 2.70; 95% CI 0.72 to 10.11; 10 trials) or for misoprostol versus other uterotonics (5/15 089 versus 3/15 369; RR 1.54; 95% CI 0.40 to 5.92; 21 trials). All 11 deaths in the misoprostol arms occurred in studies of misoprostol ≥ 600 µg.
For births occurring outside hospitals where oxytocin is not available, misoprostol could be used to prevent postpartum haemorrhage.
Date of latest search: 2 April 2013
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