title: Misoprostol versus ergometrine-oxytocin for preventing postpartum haemorrhage: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To compare the effects of misoprostol versus ergometrine-oxytocin for postpartum haemorrhage (PPH) prevention, and provide important evidence to choose optimal agents for preventing PPH in developing countries.
  
  
  METHODS
  The Cochrane Central Register of Controlled Trials, PubMed, EMbase, and ClinicalTrails.gov were searched from inception to 1st January 2016. Two authors independently extracted data and assessed risk of bias of studies according to Cochrane Handbook5.1.0. Meta-analysis was performed using RevMan5.2.4 software.
  
  
  RESULTS
  A total of 4034 women from six randomized controlled trials (RCTs) were included. Meta-analyses showed that the PPH rate (7.6% vs. 4.2%, RR = 1.81, 95%CI (1.40, 2.35), P < 0.01), and the additional uterotonic therapy (19.2% vs. 10.5%, RR = 1.83, 95%CI (1.57, 2.14), P < 0.01) for misoprostol group were significantly higher than ergometrine-oxytocin group, respectively. But there was no significant difference of severe PPH rate between two groups (1.2% vs. 0.76%, RR = 1.55, 95%CI (0.78, 3.07), P = 0.21). The need for manual removal of placenta in misoprostol was only about one-third of ergometrine-oxytocin (0.5% vs. 1.4%, RR = 0.33, 95%CI (0.15, 0.76), P < 0.01).
  
  
  CONCLUSIONS
  Misoprostol can be used in the third stage of labor for preventing PPH where sterilized syringe and trained midwife were absent, and ergoetrine-oxytocin could be deemed as alternative agent in low-resource setting due to recognized effect. As a result of limited evidence about these uterotonic agents, the more high-quality RCTs are needed to determine the potentials and harms of various uterotonic agents for preventing PPH in developing countries.
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.|Chengdu University of Traditional Chinese Medicine, Chengdu, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Tan
authors.affiliation: School of Public Administration, Southwest Jiaotong University, Chengdu, China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Cao
authors.affiliation: West China Women's and children's Hospital, Sichuan University, Chengdu, China.
authors.forename: Guo-Lin
authors.initials: GL
authors.lastname: He
authors.affiliation: West China Medical School, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Cai
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jia-Jie
authors.initials: JJ
authors.lastname: Yu
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: You-Ping
authors.initials: YP
authors.lastname: Li
mesh_terms: D004874:Ergonovine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000008:administration & dosage*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D004874:Ergonovine
keywords: Developing countries; ergometrine-oxytocin; misoprostol; postpartum haemorrhage; systematic review