Objective: To assess the effects of 400-μg sublingual misoprostol plus routine uterotonics on postpartum hemorrhage.
Methods: A double-blind, placebo-controlled, randomized study was performed. After delivery of the child, eligible women received routine uterotonics and were randomly allocated to receive 400-μg misoprostol or placebo sublingually. The primary outcome measure was blood loss of at least 500 mL within 1 hour of taking the trial tablets.
Results: In total, 672 women received misoprostol and 673 received placebo. The baseline data were similar for both groups. Misoprostol plus routine uterotonics reduced postpartum blood loss, but the effect was not significant for blood loss of at least 500 mL (relative risk [RR] 0.96; 95% confidence interval [CI], 0.63-1.45) or blood loss of at least 1000 mL (RR 0.50; 95% CI, 0.15-1.66). Misoprostol also reduced the need for non-routine oxytocin, manual removal of the placenta, and hysterectomy, but these differences were not significant either. Misoprostol was associated with pyrexia and moderate/severe shivering. There was no death in either group.
Conclusion: Misoprostol plus routine uterotonics resulted in modest reductions of blood loss in the third stage of labor, but the effects did not reach statistical significance. Larger studies are recommended.
Rationale: Postpartum haemorrhage (PPH), defined as a blood loss of 500 mL or more within 24 hours of birth, is the leading global cause of maternal morbidity and mortality. Allogenic blood transfusions are a critical component of PPH management, yet are often unfeasible, particularly in resource-poor settings where maternal morbidity is highest. Autologous cell salvage in the management of PPH has been proposed to combat limitations in access to allogenic blood and potential transfusion-related risks.
- The study investigates the effectiveness of a capacity-strengthening package to promote the use of heat-stable carbetocin (HSC) and tranexamic acid (TXA) in preventing and treating postpartum hemorrhage (PPH) in basic obstetric clinics in Uganda during crisis situations.
- A total of 2,299 women participated over a year, showing that while the use of prophylactic uterotonics was high, the introduction of HSC contributed to changes in the overall treatment practices, with a notable increase in TXA usage.
- The results highlight that enhancing healthcare provider capabilities can lead to improved management of PPH, suggesting critical implications for global health strategies in humanitarian settings.
The study assesses the impact of a capacity-strengthening package on the use of medications for preventing and treating postpartum hemorrhage (PPH) in South Sudan's basic maternity facilities.
The implementation involved a series of phases introducing therapeutic protocols, including training and resources, resulting in improved use of uterotonics and a notable increase in PPH diagnoses.
Findings indicate a transition in medication usage patterns, with oxytocin usage decreasing as heat-stable carbetocin and tranexamic acid were introduced, highlighting the need for effective PPH management strategies in crisis-affected areas.
Rationale: Postpartum haemorrhage (PPH) is common and potentially life-threatening. The antifibrinolytic drug tranexamic acid (TXA) is recommended for treating PPH; it reduces the risk of death from haemorrhage by one-third when given soon after bleeding onset, but not overall risk of death. Interest in whether TXA may be effective in preventing PPH is growing.
Background: Prior studies evaluating the relationship between psychopharmacotherapy (PPT), and postpartum hemorrhage (PPH) have yielded inconsistent findings. Clarifying this potential relationship is important for effective counseling and risk stratification.
Objectives: Our primary objective was to evaluate the association between prenatal exposure to PPT (any drug class) and the occurrence of PPH requiring transfusion of packed red blood cells (PPH+pRBC) after systematically adjusting for known hemorrhage risk factors at the time of admission for delivery.
