Evid Based Med doi:10.1136/eb-2012-100966
  • Therapeutics
  • Randomised controlled trial

Postpartum bleeding is reduced with sublingual powdered misoprostol when compared with oxytocin injection, but a new formulation of misoprostol is unlikely to revolutionise postpartum haemorrhage care

  1. Jill Durocher
  1. Gynuity Health Projects, New York, New York, USA
  1. Correspondence to: Beverly Winikoff
    Gynuity Health Projects, 15 East 26th Street, New York, NY 10010, USA; bwinikoff{at}

Commentary on:


Misoprostol is a safe and effective prophylactic option for postpartum haemorrhage (PPH). An international consensus exists in support of orally administered 600 mcg misoprostol, when oxytocin is not available or feasible,1 but most head-to-head trials suggest a lesser efficacy of misoprostol compared with that of oxytocin. Differing doses and routes of administration have also been explored in small inconclusive studies.2


A double-blind randomised controlled trial was conducted at a hospital in India to explore whether a powdered formulation of 400 mcg misoprostol sublingually was more effective than 10 IU oxytocin intramuscularly in reducing mean blood loss and PPH ≥500 ml. Misoprostol tablets were crushed, wrapped in paper and weighed. The placebo was starch. …

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