Misoprostol in the prevention of postpartum hemorrhage

OBJECTIVE: To evaluate the data regarding the use of misoprostol in the prevention of postpartum hemorrhage. DATA SOURCES: Pertinent literature was identified through a MEDLINE search (1966-January 2001) and through other secondary literature databases and/or bibliographies of pertinent articles. DATA SYNTHESIS: New strategies in the prevention of postpartum hemorrhage are being evaluated due to the obstacles surrounding conventional therapies. One therapeutic option is the use of misoprostol. This literature review evaluates the published clinical data involving misoprostol in the prevention of postpartum hemorrhage. Current data suggest that the use of misoprostol for the prevention of postpartum hemorrhage reduces mean estimated blood loss compared with placebo. However, no clinical trials have detected a statistically significant decrease in the incidence of postpartum hemorrhage in misoprostol-treated subjects. There is conflicting evidence regarding the efficacy of misoprostol compared with conventional uterotonics, such as oxytocin or Syntometrine. CONCLUSIONS: In situations where conventional oxytocics are not readily available, storage requirements for oxytocics cannot be met, or the equipment for parenteral administration is not obtainable, misoprostol may be an acceptable prophylactic option.