Misoprostol in preventing postpartum hemorrhage: a meta-analysis.
OBJECTIVE
To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world.


METHODS
Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics.


RESULTS
This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug.


CONCLUSIONS
Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all.
Langenbach
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Epidemiology and Biostatistics, School of Public Health, University of California at Berkeley, CA, USA. colangenbach@yahoo.com
D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D010120:Oxytocics; D016595:Misoprostol