Misoprostol for the management of postpartum bleeding: a new approach

Excessive postpartum hemorrhage (PPH) is a leading cause of maternal death globally. Current approaches to address PPH at the community level focus on reducing the incidence of PPH, but often fail to address the issue of PPH treatment. Given that institutional delivery is not yet a reality for all women, comprehensive care for excessive bleeding after delivery needs to be available at the community level. A new hybrid model of "secondary prevention"-presumptive treatment for women with more than average blood loss-presents one alternative community-based approach. If shown to be effective and feasible, this approach could support policy changes and avoid the need to provide uterotonics to all women after delivery. This Special Communication discusses some of the benefits and limitations of current community approaches using misoprostol for PPH prevention and explains why it is now opportune to translate clinical knowledge into pragmatic PPH service delivery strategies.