THERAPEUTICS
Review: misoprostol and intramuscular prostaglandins do not prevent postpartum haemorrhage more than injectable uterotonics
| The first 150 words of the full text of this article appear below. |
Dr A M Gülmezoglu
Correspondence to: Dr A M Gülmezoglu, World Health Organization, Geneva, Switzerland; gulmezoglum@who.int
QUESTION
How effective are prophylactic prostaglandins in preventing postpartum haemorrhage (PPH)?
REVIEW SCOPE
Selected studies compared a prostaglandin with no uterotonic agent, placebo, or another uterotonic agent as part of the routine management of the third stage of labour. Outcomes were severe PPH (blood loss 
1000 ml), need for blood transfusion, use of additional uterotonics, and adverse effects.
REVIEW METHODS
Cochrane Pregnancy and Childbirth Group’s trials register (February 2007) and PubMed (July 2006) were searched for randomised controlled trials (RCTs). 46 RCTs (n = 42 621) were included; 32 used adequate allocation concealment.
MAIN RESULTS
The table shows results for oral misoprostol. Rectal misoprostol did not differ from placebo for severe PPH or use of additional uterotonics (1 RCT, n = 546); the table shows results for comparison with injectable uterotonics. Sublingual misoprostol reduced the risk of severe PPH by 34%
Université de Montreal, Montreal, Quebec, Canada
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Drugs: obstetrics and gynaecology
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