Prostaglandins for preventing postpartum haemorrhage

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Evidence-Based Medicine

Background:

• Prostaglandins are typically reserved for severe postpartum hemorrhage (PPH).
• Misoprostol, a prostaglandin E1 analogue, is proposed for routine third-stage labor management due to its affordability and availability.

Purpose of the Study:

• To evaluate the efficacy and safety of prophylactic prostaglandin use during the third stage of labor.
• To compare prostaglandin agents against other uterotonics or placebo for PPH prevention.

Main Methods:

• Systematic review of randomized controlled trials from Cochrane Pregnancy and Childbirth Group's Trials Register and PubMed.
• Included trials compared prostaglandin agents with other uterotonics or placebo.
• Primary outcomes: blood loss ≥1000 ml and additional uterotonic use.

Main Results:

• Oral or sublingual misoprostol showed potential in reducing severe PPH and blood transfusions compared to placebo.
• However, oral misoprostol was linked to a higher risk of severe PPH and increased need for additional uterotonics versus conventional injectable agents.
• Misoprostol use was associated with increased shivering and pyrexia (temperature of 38°C).

Conclusions:

• Oral or sublingual misoprostol (600 mcg) may reduce postpartum blood loss compared to placebo.
• Injectable prostaglandins or misoprostol are not preferable to conventional injectable uterotonics for third-stage labor management, especially in low-risk women.
• Further research is needed to determine optimal dosing and administration routes for misoprostol to minimize side effects.