Postpartum hemorrhage in the developed world: Whither misoprostol
American Journal of Obstetrics and Gynecology, 08/03/2012
Gibbins KJ et al. – Authors conclude that in settings where oxytocin is available, oxytocin should remain the mainstay of both prophylaxis and first–line treatment of postpartum hemorrhage due to uterine atony. In the developed world, the use of misoprostol for postpartum hemorrhage should be infrequent.
- They reviewed the literature to determine the optimal medical treatment of postpartum hemorrhage due to uterine atony.
- Of the available uterotonics, only misoprostol and oxytocin have undergone rigorous comparative study.
- Of the two, misoprostol is inferior: two recent well–done randomized trials with enrollment of over 2,200 demonstrate that, in situations where prophylactic oxytocin has already been utilized, additional oxytocin is as effective or better than misoprostol in terminating bleeding, while avoiding the high rate of fever (22% to 58%) associated with misoprostol.
- The second of these trials demonstrates that misoprostol does not augment the effect of oxytocin.