Treatment for primary postpartum haemorrhage needs more research.
After a woman gives birth, womb muscles contract, clamping down on the blood vessels and helping to limit bleeding when the placenta has detached. If the muscles do not contract strong enough, postpartum haemorrhage (very heavy bleeding) can occur, which can be life-threatening. These situations are common in resource-poor countries, and maternal mortality is about one hundred times higher than in resource-rich countries. It is a serious problem that requires effective treatments which might avert the use of surgery to remove the womb (hysterectomy), often the last treatment option. The earlier treatment options include drugs to increase muscle contractions (such as ergometrine, oxytocin and prostaglandins), surgical techniques (such as tying off or blocking the uterine artery), radiological interventions (such as blocking of the main artery to the womb using gel foams), and haemostatic drugs (such as tranexamic acid and recombinant activated factor VII). The review identified three trials involving 462 women that assessed treatment with the drug misoprostol, but there were no trials about the effects of surgical techniques, radiological interventions or haemostatic drugs. One small trial showed a possible benefit of rectal misoprostol compared with standard combination of ergometrine and oxytocin. However, more research is needed before newer drugs, like misoprostol, can be tried as a first-line drug treatment to be sure that maternal mortality is not increased and to further assess the possible impact of adverse side-effects like shivering, nausea and headaches.