Misoprostol for preventing PPH: some lessons learned.

摘要

During the past decade, The Lancet has led the debate over the use of misoprostol for prevention of postpartum haemorrhage. A letter published in 1996 first suggested the use of misoprostol for the third stage of labour.Here was a drug that seemed perfectly designed to reduce blood loss in childbirth. Misoprostol is an inexpensive heat-stable prostaglandin El analogue with strong uterotonic activity that can be given without the need for sterile needles and syringes. Huge interest was generated and, in the ensuing 10 years, more than 30 randomised trials in more than 30 000 women were done to study misoprostol for prophylaxis of postpartum haemorrhage. In 2001, another landmark was the publication of the WHO multicentre randomised study,3 which showed that parenteral oxytocin was preferable to misoprostol for prevention of postpartum haemorrhage in hospital settings. Despite the flurry of protests that followed,4 the results of the WHO study overwhelmed the existing evidence, and the subsequentCochranereview concluded that misoprostol was not preferable to conventional injectable uterotonics for the third stage of labour, especially for low-risk women.The Cochrane authors also saw no convincing evidence that misoprostol was better than placebo or giving nothing in prevention of postpartum haemorrhage.