Postpartum hemorrhage (PPH) is a serious complication of pregnancy that impacts birth outcomes across all economies. In rural, low-income settings, medical professionals have been using Misoprostol, a drug approved for the treatment of gastric ulcers, as a means of preventing PPH. The drug is listed on the World Health Organization’s (WHO) list of Essential Medicines with a description that claims the drug can be used for this purpose – but there is no clinical support for this suggestion, according to a report published in the Journal of the Royal Society of Medicine.
Researchers from two medical organizations in London reviewed current studies on Misoprostol in hopes of finding some support for using the drug as a preventative measure against PPH, but they found a clear lack of such support. Of the 172 studies available on using Misoprostol during labor for the prevention of PPH, only six provided adequate information for review. None of the six studies proved statistical improvements in PPH rates and many lacked control, form or relevance to the medical topic. According to Professor Allyson Pollock, study author, the best case scenario is that all studies on the subject on inconclusive. There is no one study the author reviewed that showed any benefit in terms of impacting PPH rates.
Despite the lack of medical evidence, WHO currently lists the drug as a crucial tool for preventing PPH. Countries like Nepal, India and Uganda are not only using the drug in a clinical setting – they are promoting the use of the drug to expand use. About 25% of the nearly 345,000 deaths in 2008 that occurred during childbirth or pregnancy were caused by PPH. Many of these deaths were noted in countries with low to moderate income levels.
Researchers note many of the cases of PPH are associated with anemia during pregnancy. If pregnancy screening for anemia were enforced and expanded, patients with anemia could be treated thus reducing the risk of PPH without medication. Education on proper post-birth care is also important to overall survival rates.
Misoprostol is a drug that keeps well in all environments. It does not require refrigeration. The drug does not require IV administration, so rural birth settings are the perfect place to use the drug. However, no matter how ideal the drug is for rural births, if the drug is ineffective, women are not being protected from PPH.
Source: C.S. Chu, P. Brhlikova and A.M. Pollock. J R Soc Med. 2012 Aug;105(8):336-47. Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage.