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The drug misoprostol, condemned as dangerous when used "off label" for purposes such as inducing labor or as an adjunctive drug during elective abortions has been proven to be a safe, convenient, and inexpensive means to prevent postpartum hemorrhage, a major killer of women in developing countries. In developed countries, where the majority of births occur in hospitals and emergency care is available, deaths from postpartum hemorrhage are rare. However, the condition can be life-threatening in countries where most births occur at home and emergency care is not always available. In rural , where the study took place, 50 % of births occur at home or in facilities without a physician in attendance and estimated maternal death rate in that country is 407 women for every 100,000 births. The study also cited estimates that, worldwide, about 500,000 maternal deaths occur during childbirth each year, with postpartum hemorrhage accounting for about 30 percent of those deaths. The comparable rate in the is about 10 maternal deaths per 100,000 births, with postpartum hemorrhage accounting for about 17 percent of these deaths. The study, which was conducted by researchers from the University of Missouri, India's Jawaharlal Nehru Medical College, and the National Institutes of Health, appears in the October 7, 2006 issue of Lancet and was funded by the Global Network for Women's and Children's Health Research, a public-private partnership between the National Institute of Child Health and Human Development (part of the National Institutes of Health) and the Bill and Melinda Gates Foundation. The study, conducted between September, 2002, and December, 2005, was a placebo-controlled trial involving 1,620 women in rural who received either oral misoprostol or a placebo after delivery. 25 auxiliary nurse midwives undertook the deliveries, administered the study drug, and measured blood loss. At the conclusion of the study it was found that only 6.4 % of the women that received misoprostol were likely to have experienced acute postpartum hemorrhage (defined as the loss of from 500 milliliters [ml] to just under 1000 ml of blood or slightly more than a pint to slightly more than a quart.) compared with 12 % in the placebo group. The misoprostol group also had fewer occurrences of acute severe postpartum hemorrhage - the loss of 1000 ml or more of blood. Overall, the researchers reported that one case of postpartum hemorrhage was prevented for every 18 women treated. In developed countries, oxytocin is the standard drug used to prevent postpartum hemorrhage and stops bleeding in the uterus by causing the uterus to contract. However, oxytocin must be kept cold and must be given by trained medical personnel - conditions that make it unsuitable for use in parts of the world where most births are at home and refrigeration and skilled medical personnel are in short supply. Misoprostol, which also stops uterine bleeding by causing the uterus to contract, does not require refrigeration, can be given once after delivery as 3 oral tablets costing as little as $.14 each, and does not require highly trained personnel and it can be given by semi-skilled birth attendants. According to the summary appearing with the Lancet report "Oral misoprostol was associated with significant decreases in the rate of acute postpartum hemorrhage and mean blood loss. The drug's low cost, ease of administration, stability, and a positive safety profile make it a good option in resource-poor settings." Disclaimer The information presented in this article and its included links is of an informational nature only and is not intended as a recommendation of any changes in the reader's health care program. Before making any changes in diet, medications, or other treatments the reader is strongly advised to consult with their health care provider. |
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