Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in home births in Pakistan: randomised placebo-controlled trial.
Document Type
Article
Department
Community Health Sciences
Abstract
Objective: To determine if misoprostol is safe and efficacious in preventing postpartum haemorrhage (PPH) when administered by trained traditional birth attendants (TBA) at home deliveries. Design: A randomised, double-blind, placebo-controlled trial. Setting: Chitral, Khyber Pakhtunkhwa Province, Pakistan. Population: A total of 1119 women giving birth at home. Methods: From June 2006 to June 2008, consenting women were randomised to receive 600 microg oral misoprostol (n = 534) or placebo (n = 585) after delivery to determine whether misoprostol reduced the incidence of PPH (≥ 500 ml). Main Outcomes Measures: The primary outcomes were measured blood loss ≥ 500 ml after delivery and drop in haemoglobin >2 g/dl from before to after delivery. Results: Oral misoprostol was associated with a significant reduction in the rate of PPH (≥ 500 ml) (16.5 versus 21.9%, relative risk 0.76, 95% CI 0.59-0.97). There were no measurable differences between study groups for drop in haemoglobin >2 g/dl (relative risk 0.79, 95% CI 0.62-1.02), but significantly fewer women receiving misoprostol had a drop in haemoglobin >3 g/dl, compared with placebo (5.1 versus 9.6%, relative risk 0.53, 95% CI 0.34-0.83). Shivering and chills were significantly more common with misoprostol. There were no maternal deaths among participants. Conclusion: Postpartum administration of 600 microg oral misoprostol by trained TBAs at home deliveries reduces the rate of PPH by 24%. Given its ease of use and low cost, misoprostol could reduce the burden of PPH in community settings where universal oxytocin prophylaxis is not feasible. Continual training and skill-building for TBAs, along with monitoring and evaluation of programme effectiveness, should accompany any widespread introduction of this drug.
Publication (Name of Journal)
Bjog-An International Journal of Obstetrics and Gynaecology
Recommended Citation
Durocher, J.,
Blum, J.,
Walraven, G.,
Zuberi, N.,
Mobeen, N.
(2011). Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in home births in Pakistan: randomised placebo-controlled trial.. Bjog-An International Journal of Obstetrics and Gynaecology, 118(8), 1018-1019.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/38