Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial.
OBJECTIVE
To assess the effectiveness of 600 microg oral misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low income country home birth situation.


METHODS
Double blind randomised controlled trial.


METHODS
Twenty-six villages in rural Gambia with 52 traditional birth attendants (TBAs).


METHODS
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-microg misoprostol tablets and placebo or four 0.5-mg ergometrine tablets (standard treatment) and placebo. Tablets were taken orally immediately after delivery.


METHODS
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 > or =500 mL and postpartum Hb <8 g/dL, but the differences were not statistically significant. The reduction in postpartum (compared with pre-delivery) Hb > or = 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.
Walraven
Gijs
G
Farafenni Field Station, Medical Research Council Laboratories, Farafenni, Gambia.
Blum
Jennifer
J
Dampha
Yusupha
Y
Sowe
Maimuna
M
Morison
Linda
L
Winikoff
Beverly
B
Sloan
Nancy
N
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D000740:Anemia / Q000517:prevention & control; D003906:Developing Countries; D004311:Double-Blind Method; D005260:Female; D005714:Gambia; D006700:Home Childbirth / Q000451:nursing*; D006801:Humans; D007749:Labor Stage, Third; D008880:Midwifery; D016595:Misoprostol / Q000008:administration & dosage*; D007744:Obstetric Labor Complications / Q000188:drug therapy*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000517:prevention & control; D012423:Rural Health; D013607:Tablets
D000020:Abortifacient Agents, Nonsteroidal; D013607:Tablets; D016595:Misoprostol