Misoprostol for prevention and treatment of postpartum hemorrhage : a systematic review

[摘要] ENGLISH ABSTRACT: Background: Misoprostol, a prostaglandin E1 analogue with its uterotonic propertieshas entered as an integral part of management of the third stage of labour, helping toprevent postpartum haemorrhage (PPH).Objective: To assess evidence on the effectiveness of misoprostol compared to aplacebo for the prevention and treatment of postpartum haemorrhage.Methods: Databases searched included; MEDLINE, Google Scholar and CochraneCentral Register of Controlled Trials (CENTRAL). Other sources were also searched.All articles were screened for methodological quality by two reviewers independently bystandardized instrument. Data was entered in Review Manger 5.1 software for analysis.Results: Three Misoprostol studies were included (2346 participants), Oral (2 trials) andsublingual (1 trial). Misoprostol has shown not to be effective in reducing PPH (RR0.65: 95% CI 0.40-1.06). Only one trial reported on need for blood transfusion (RR0.14; 95% CI 0.02-1.15). Misoprostol use is associated with significant increases inshivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) thanwith placebo. No maternal deaths were reported in included trials. Compared toplacebo, misoprostol was coupled with less hysterectomies and additional used ofuterotonics (RR 0.45; 95%CI 0.21-0.96) compared to placebo.Conclusion: Results of this review shows that the use of misoprostol in combinationwith some components of active management was not associated with any significantreduction in incidence of PPH. However oral administration showed a significantreduction in incidence of PPH. For its use for treatment of postpartum haemorrhage,there is a need for research focus in optimal dose and route of administration for aclinically significant effect and acceptable side effects.

[发布机构] Stellenbosch University