Author Walraven, Gijs a; Blum, Jennifer b; Dampha, Yusupha a; Sowe, Maimuna
a; Morison, Linda c; Winikoff, Beverly d; Sloan, Nancy b
Institution (a)Farafenni Field Station, Medical Research Council
Laboratories, Farafenni, Gambia
(b)Population Council, New York, USA
(c)London School of Hygiene and Tropical Medicine, London, UK
(d)Gynuity Health Projects, New York, USA
Title Misoprostol in the management of the third stage of labour in the home
delivery setting in rural Gambia: a randomised controlled
trial.[Miscellaneous Article]
Source BJOG: An International Journal of Obstetrics & Gynaecology.
112(9):1277-1283, September 2005.
Abstract Objective: To assess the effectiveness of 600 [mu]g oral
misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low
income country home birth situation.
Design: Double blind randomised controlled trial.
Setting: Twenty-six villages in rural Gambia with 52 traditional birth
attendants (TBAs).
Sample: One thousand, two hundred and twenty-nine women delivering at home
under the guidance of a trained TBA.
Methods: Active management of the third stage of labour using three
200-[mu]g misoprostol tablets and placebo or four 0.5-mg ergometrine tablets
(standard treatment) and placebo. Tablets were taken orally immediately
after delivery.
Main outcome measures: Measured blood loss, postpartum haemoglobin (Hb),
difference between Hb at the last antenatal care visit and three to five
days postpartum.
Results: The misoprostol group experienced lower incidence of measured blood
loss >=500 mL and postpartum Hb <8 g/dL, but the differences were not
statistically significant. The reduction in postpartum (compared with
pre-delivery) Hb >= 2 g/dL was 16.4% with misoprostol and 21.2% with
ergometrine [relative risk 0.77; 95% confidence interval (CI) 0.60-0.98; P=
0.02]. Shivering was significantly more common with misoprostol, while
vomiting was more common with ergometrine. Only transient side effects were
observed.
Conclusions: Six hundred micrograms of oral misoprostol is a promising drug
to prevent life-threatening PPH in this setting.
Copyright (C) 2005 Blackwell Publishing Ltd.
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