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Randomised controlled trial
Oral misoprostol reduces the risk of postpartum haemorrhage in home births assisted by trained traditional birth attendants in Pakistan
  1. G Justus Hofmeyr1,2
  1. 1Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
  2. 2Eastern Cape Department of Health, East London, South Africa
  1. Correspondence to G Justus Hofmeyr
    Frere Maternity Hospital, Private Bag X9047, East London 5201, South Africa; justhof{at}

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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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  • Competing interests None.