Prevention of postpartum hemorrhage with misoprostol

As a stable, orally active and cheap uterotonic, misoprostol would appear ideally suited to the prevention of postpartum hemorrhage (PPH) in the developing world. Following numerous clinical trials, it appears that misoprostol prophylaxis using an oral or sublingual dose of 600 μg is more effective than placebo at preventing PPH in community births (relative risk 0.59, 95% confidence intervals 0.41–0.84), but not in hospital settings (RR 1.23, 95% CI 0.86–1.74). It is, however, not as effective as injectible oxytocin (RR 1.34, 95% CI 1.16 to 1.55). Misoprostol is therefore indicated for prevention of PPH in settings where injectible conventional uterotonics are not available. In the event of continued hemorrhage, a minimum of 2 h should lapse after the original dose before a second dose is given. If the initial dose was associated with pyrexia or marked shivering, at least 6 h should lapse before the second dose is given.