Misoprostol In Practice

M. Potts

Prior to the availability of misoprostol, it was impossible to carry any significant element of emergency obstetric care into homes where women deliver without a skilled birth attendant. As a low-cost, easy-to-administer, powerful uterotonic with an excellent safety profile and long shelf-life, misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage in precisely those situations where it is most common - delivery at home without a skilled birth attendant.

In a placebo-controlled, community-based trial in India, administration of 600 |ig miso-prostol orally immediately after delivery significantly reduced postpartum hemorrhage (see Addendum). Research in Indonesia, Nepal and elsewhere is showing that community volunteers with minimal training can teach illiterate women to self-administer misoprostol effectively and responsibly1 (see Chapter 19). A 1000 |g rectal dose of misoprostol can be used to treat postpartum hemorrhage, in situations where an appropriate technology exists to diagnose blood loss (such as blood-soaked sarong or 'kanga'), and where births are attended by traditional birth attendants (TBAs). In Tanzania, illiterate TBAs, with a brief training, used misoprostol to bring about a highly significant reduction in the number of women who needed to be referred to hospital or receive intravenous treatment2.

Although these measures may seem revolutionary at first glance, they should be viewed as an essential step towards a long-term strategy where all women can be delivered by a certified midwife or physician practicing active management of the third stage of labor. Over the past half-century, countries such as Sri Lanka and Thailand have brought maternal mortality to low levels by ensuring over 90% of deliveries are attended by a skilled person able to use an oxytocic, and ultimately all countries should follow such a path.

Unfortunately, rapid population growth, economic collapse and the spread of HIV/ AIDS in some African countries and the endless recruitment of skilled health professions from developing to developed countries will make the road to providing comprehensive obstetric care long and slow. During this interval, widespread access to misoprostol and the education to use it safely during home births have the potential to make a significant contribution - perhaps even the single most important contribution - to reducing the global burden of deaths from postpartum hemorrhage. The only other practical intervention with the potential to reduce postpartum hemorrhage in low-resource settings is realistic access to family planning, as all women who wish to limit childbearing are at risk of postpartum hemorrhage, and the older, higher-parity women, who have the greatest unmet need for family planning, are at even higher risk.

Pregnancy And Childbirth

Pregnancy And Childbirth

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