title: Risk of fever after misoprostol for the prevention of postpartum hemorrhage: a meta-analysis.
abstract: OBJECTIVE
  To estimate the incidence and risk of misoprostol-induced fever with different doses and routes when used for the prevention of postpartum hemorrhage.
  
  
  METHODS
  We searched MEDLINE, the Cochrane CENTRAL, and PubMed free-text terms "misoprostol AND third stage of labor," "misoprostol AND third stage of labour," "misoprostol AND postpartum hemorrhage," and "misoprostol AND postpartum haemorrhage." Randomized trials with at least one group randomized to misoprostol administered by any route to prevent postpartum hemorrhage were included.
  
  
  METHODS
  Two hundred thirty-one studies were initially identified and 61 of them were assessed for eligibility. We excluded nonrandomized trials, studies without a control group, and trials that did not record the rate of fever. The date of last search was July 20, 2010. Data were extracted, tabulated, and analyzed with Reviewer Manager software.
  
  
  RESULTS
  We included 33 trials with 38,478 participants in the final analysis. The highest reported incidence of fever was in the sublingual route (15%) with lower rates with the oral (11.4%) and rectal (4%) routes. The overall risk ratio of fever with misoprostol in comparisons with placebo and other uterotonics was approximately 5. There was frequent heterogeneity, however, which could not be explained by study quality or publication date.
  
  
  CONCLUSIONS
  The incidence of fever with misoprostol is related to both its dosage and route with the highest incidences found in the high-dose sublingual routes. However, this is not the only influence on postnatal fever. There appear also to be other effects that could be genetic or cultural.
authors.affiliation: Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom.
authors.forename: Anisa
authors.initials: A
authors.lastname: Elati
authors.forename: Andrew
authors.initials: A
authors.lastname: Weeks
mesh_terms: D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007749:Labor Stage, Third / Q000187:drug effects*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D016595:Misoprostol