title: Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial.
abstract: 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.
authors.affiliation: Farafenni Field Station, Medical Research Council Laboratories, Farafenni, Gambia.
authors.forename: Gijs
authors.initials: G
authors.lastname: Walraven
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blum
authors.forename: Yusupha
authors.initials: Y
authors.lastname: Dampha
authors.forename: Maimuna
authors.initials: M
authors.lastname: Sowe
authors.forename: Linda
authors.initials: L
authors.lastname: Morison
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
authors.forename: Nancy
authors.initials: N
authors.lastname: Sloan
mesh_terms: 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
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D013607:Tablets; D016595:Misoprostol