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Review: misoprostol and intramuscular prostaglandins do not prevent postpartum haemorrhage more than injectable uterotonics

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Dr A M Gülmezoglu

Correspondence to: Dr A M Gülmezoglu, World Health Organization, Geneva, Switzerland;


How effective are prophylactic prostaglandins in preventing postpartum haemorrhage (PPH)?


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.


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.


The table shows results for oral misoprostol. Rectal misoprostol …

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  • Source of funding: no external funding.