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Postpartum misoprostol for preventing maternal mortality and morbidity

Hofmeyr G, Gülmezoglu A, Novikova N, Lawrie TA
Published Online: 
15 July 2013

Bleeding from the uterus or womb after childbirth is normal, but excessive bleeding (haemorrhage) is an important cause of death and can be reduced by medication that causes the uterus to contract. Misoprostol is one such medication and is a tablet marketed to treat certain stomach ulcers but which also contracts the uterus and reduces bleeding. It may also have harmful side effects, in particular raised body temperature (pyrexia) and shivering. Misoprostol can more easily be distributed at community level than less stable, injectable medication such as oxytocin to prevent or treat severe bleeding in woman after giving birth (postpartum haemorrhage). This review investigated whether giving misoprostol to women after birth to prevent or treat excessive bleeding reduces maternal deaths and severe complications other than blood loss (which is covered in separate reviews). We included 78 randomised controlled studies involving 59,216 women. The variety of study designs, populations studied, routes of administration and co-interventions, as well as the exceptionally high incidence of hyperpyrexia in Ecuador were limiting factors. Maternal deaths, and the combined outcome, death or severe illness resulting in major surgery, admission to intensive care or vital organ failure (excluding very high fever) were not reduced by misoprostol. The known side effects of misoprostol (fever and very high fever) were worse with dosages of 600 µg or more than with lower dosages. Therefore, the review supports the use of the lowest effective misoprostol dose to prevent or treat maternal bleeding after the birth of the baby, and calls for more research to find out the optimal dosage, with continued surveillance for serious side effects.

This record should be cited as: 
Hofmeyr G, Gülmezoglu A, Novikova N, Lawrie TA. Postpartum misoprostol for preventing maternal mortality and morbidity. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD008982. DOI: 10.1002/14651858.CD008982.pub2
Assessed as up to date: 
2 April 2013