title: Misoprostol  for the prevention and treatment of postpartum hemorrhage.
abstract: BACKGROUND
  Uterotonic drugs are recommended for the prevention and treatment of postpartum hemorrhage (PPH), and oxytocin is considered the gold standard for both indications due to its established efficacy and safety. Unfortunately, access to oxytocin is still limited in many low-resource settings due to the need for cool storage, sterile equipment and administration by skilled personnel. Misoprostol , an E1 prostaglandin analog, has therefore been explored as an alternative for such settings due to its proven ability to induce uterine contractions, low cost, stability at room temperature and ease of administration.
  
  
  METHODS
  This review covers evidence from 51 randomized controlled trials for both prevention and treatment of PPH. It discusses efficacy and side effects in the context of the various doses that have been studied using oral, sublingual or rectal routes of administration for both indications.
  
  
  CONCLUSIONS
  There is now a solid body of evidence to justify the use of misoprostol for postpartum hemorrhage indications in many settings. The evidence supports use of 600 μg orally for the prevention of PPH and 800 μg sublingually for the treatment of PPH. There is no evidence to support the adjunct use of misoprostol following administration of conventional uterotonics for prevention or treatment purposes.
authors.affiliation: Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY 10010, USA.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Sheldon
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blum
authors.forename: Jill
authors.initials: J
authors.lastname: Durocher
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D010120:Oxytocics; D016595:Misoprostol