Postpartum misoprostol for preventing maternal mortality and morbidity

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Public Health

Background:

• Postpartum haemorrhage (PPH) prevention and treatment are critical for reducing maternal mortality.
• Misoprostol offers a public health advantage due to its ease of community-level distribution compared to injectables.
• Surveillance of randomized trials is essential to monitor misoprostol's adverse effects beyond blood loss, particularly as its use expands globally.

Purpose of the Study:

• To systematically review maternal deaths and severe morbidity from all randomized trials assessing misoprostol for PPH prevention or treatment.

Main Methods:

• Searched the Cochrane Pregnancy and Childbirth Group's Trials Register for relevant randomized trials.
• Included trials involving pregnant women receiving postpartum misoprostol versus placebo/no treatment or other uterotonics.
• Extracted data on maternal death, severe morbidity, and pyrexia, with two independent reviewers assessing trial inclusion.

Main Results:

• No significant difference in maternal mortality was found between misoprostol and control groups (RR 2.08, 95% CI 0.82 to 5.28).
• A significant increase in 'maternal death or severe morbidity' was observed with misoprostol versus placebo (RR 1.70, 95% CI 1.02 to 2.81), but not versus other uterotonics.
• Pyrexia (>38°C) was significantly increased with misoprostol (RR 3.97, 95% CI 3.13 to 5.04), particularly at doses ≥600 µg.

Conclusions:

• Misoprostol does not appear to alter severe morbidity (excluding hyperpyrexia) or maternal mortality in PPH management.
• An increased risk of pyrexia is associated with misoprostol, especially at higher dosages (≥600 µg).
• Findings support using the lowest effective dose of misoprostol and continued vigilance for adverse effects, necessitating further large trials.