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Death from postpartum haemorrhage (PPH) is frequently unpredictable and rapid. The global burden of these deaths disproportionately affects women giving birth in remote environments, without skilled birth attendance. Recent efforts to provide access to elements of the ‘active management of the third stage of labour’ in these settings have focused on misoprostol, a uterotonic agent that requires neither refrigeration nor parenteral administration.
Mobeen and colleagues conducted a randomised, double blind, placebo-controlled trial in Chitral, Khyber Pakhtunkhwa Province, Pakistan. Traditional birth attendants at home births were trained to administer oral misoprostol 600 µg or placebo after birth of the baby, to collect blood loss for subsequent measurement and to refer women with birth complications for further care. The random sequence was computer generated in balanced blocks of six.
The blood loss measurement procedures for the first 7 months of the trial were considered to be flawed, and the results of 370 women …
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