title: Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial.
abstract: OBJECTIVE
  to determine if misoprostol is safe and efficacious in preventing postpartum haemorrhage (PPH) when administered by trained traditional birth attendants (TBA) at home deliveries.
  
  
  METHODS
  a randomised, double-blind, placebo-controlled trial.
  
  
  METHODS
  Chitral, Khyber Pakhtunkhwa Province, Pakistan.
  
  
  METHODS
  a total of 1119 women giving birth at home.
  
  
  METHODS
  from June 2006 to June 2008, consenting women were randomised to receive 600 microg oral misoprostol (n = 534) or placebo (n = 585) after delivery to determine whether misoprostol reduced the incidence of PPH (≥ 500 ml).
  
  
  METHODS
  the primary outcomes were measured blood loss ≥ 500 ml after delivery and drop in haemoglobin >2 g/dl from before to after delivery.
  
  
  RESULTS
  oral misoprostol was associated with a significant reduction in the rate of PPH (≥ 500 ml) (16.5 versus 21.9%; relative risk 0.76, 95% CI 0.59-0.97). There were no measurable differences between study groups for drop in haemoglobin >2 g/dl (relative risk 0.79, 95% CI 0.62-1.02); but significantly fewer women receiving misoprostol had a drop in haemoglobin >3 g/dl, compared with placebo (5.1 versus 9.6%; relative risk 0.53, 95% CI 0.34-0.83). Shivering and chills were significantly more common with misoprostol. There were no maternal deaths among participants.
  
  
  CONCLUSIONS
  postpartum administration of 600 microg oral misoprostol by trained TBAs at home deliveries reduces the rate of PPH by 24%. Given its ease of use and low cost, misoprostol could reduce the burden of PPH in community settings where universal oxytocin prophylaxis is not feasible. Continual training and skill-building for TBAs, along with monitoring and evaluation of programme effectiveness, should accompany any widespread introduction of this drug.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Gynuity Health Projects, New York, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Mobeen
authors.forename: J
authors.initials: J
authors.lastname: Durocher
authors.forename: Nf
authors.initials: N
authors.lastname: Zuberi
authors.forename: N
authors.initials: N
authors.lastname: Jahan
authors.forename: J
authors.initials: J
authors.lastname: Blum
authors.forename: S
authors.initials: S
authors.lastname: Wasim
authors.forename: G
authors.initials: G
authors.lastname: Walraven
authors.forename: J
authors.initials: J
authors.lastname: Hatcher
mesh_terms: D000284:Administration, Oral; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006700:Home Childbirth; D006801:Humans; D008880:Midwifery; D016595:Misoprostol; D010120:Oxytocics; D010154:Pakistan; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D016595:Misoprostol