Use of misoprostol for prevention and treatment of post-partum haemorrhage.
The WHO has recently added misoprostol to WHO's Model List of Essential medicines, for the prevention of post-partum haemorrhage (PPH) "in settings where oxytocin is not available or cannot be safely used". The committee rejected a related appeal to include misoprostol on the list for the treatment of PPH, as evidence shows oxytocin is superior. (1)
For decades, oxytocin and ergometrine have been the treatments of choice for PPH, but both drugs can be given only by injection and require refrigeration. They are therefore of limited availability and benefit in low-resource settings, especially in rural areas. Misoprostol, however, can be administered orally and does not need refrigeration. Gynuity Health Projects and WHO have recruited over 80,000 women in 14 centres worldwide to three randomised, controlled trials to define the role of misoprostol in PPH. Misoprostol was found to be less effective than oxytocin for PPH treatment, to have more side effects and no additional benefit if the woman has already been given oxytocin. However, misoprostol was found to be better than nothing. Its ease of use means that all midwives and doctors in rural low-resource settings could carry a stock. A large placebo-controlled randomised trial is now under way to test the hypothesis that giving misoprostol to women antenatally for self-administration immediately after delivery may be a safe and effective strategy. If true, this would provide an effective, self-administered treatment for the first time for those women most at risk of death from PPH, and help reduce maternal mortality worldwide. (2)
(1.) Health: childbirth made safer. IRIN News, 13 May 2011.
(2.) Elati A, Weeks A. Misoprostol for the management of post-partum haemorrhage. BMJ 2011;342:d2877.