Eldis.org

RESEARCH IN FOCUS:
The role of misoprostol in making home births safer ABOUT THIS RESEARCH IN
BACKGROUND
FOCUS
THIS DOCUMENT
POSTPARTUM HAEMORRHAGE
AND MISOPROSTOL
(Sutherland and Bishai, 2009). In the past it has not been possible to quantify the effects Misoprostol is a safe, effective and low cost of this intervention on death rates empirically due to the large sample size that would be required. The research used mathematical world, and has been available in generic formulation for several years. It has been delivery outcomes of 10,000 women. In India, used exte nsively for the prevention of gastric 83% of rural deliveries occur at home. There ulcers. It is also used to contract the uterus are 540 maternal deaths per 100,000 live to preven t and/or stop excessive bleeding. births and 36% of these are due to postpartum Derman et al. conducted a trial of orally administered misoprostol in rural India with conditions that can be prevented in the home decreases in the rate of acute postpartum interventions that do not require clinic or hospital care. Misoprostol is manufactured in India and is widely available for around 33 If misopro stol is administered by an untrained provider, it may lead to severe complications. In our simulation, misoprostol use after Advocates of misoprostol use after delivery delivery led to a 38% reduction in maternal training and development of differentiated haemorrhage. Cost effectiveness is a critical packing fo r each indication of misoprostol use element in shaping national and international donor policy and subsequent intervention, distribution and use. The median cost of package would contain three 200ug tablets of preventing each death was $1,401. This cost misoprostol and would be clearly labelled for compares favourably to other public health obstetric care per life saved is $10,532 misoprostol as it can also be used for medical (Jamison et al., 2006). Our model shows that abortion. In some settings it is procured misoprostol is cost-effective. With greater use, misoprostol could save the lives of tens administe red to induce abortion. This often occurs w here safe abortion services are unavailable due to the law or inaccessible due to reasons such as prohibitive cost. NEW EVI DENCE FROM FUTURE HEALTH
Research Programme Consortium, ‘Cost-
effe
ctiveness of misoprostol and prenatal
iron
supplementation
as
maternal
mortality interventions in home births in
rural India’, has added to the body of
knowledge on the delivery of misoprostol by
skilled providers outside the health system
FUTURE HEALTH SYSTEMS
RESEARCH IN FOCUS
REFERENCES:
Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch
rtwell T, Chakraborty H, Moss N. (2006) Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. The Lancet. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, editors. Disease Control es in Developing Countries. New York: Oxford University Press; 2006 Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. (2006) WHO analysis of causes of matern al death: a systematic review. The Lancet 2006;367(9516):1066–74 D. (1993) Safe motherhood programs: options and issues. New York: Columbia University; McCorm ick ML, Sanghvi HCG, Kinzie V, McIntosh N. (2002) Preventing postpartum haemorrhage in low-res ource settings. International Journal of Gynecology & Obstetrics 2002;77(267-275) Mousa H, Alfirevic Z. (2007) Treatment for primary postpartum haemorrhage. Cochrane Database Sanghvi H, Gulardi W, Changpong G, Fishel J, Ahmed S, Zulkarnin M. (2004) Prevention of Postpar tum Hemorrhage Study, West Java, Indonesia. Baltimore, USA: JHPIEGO; 2004 Sutherland T and Bishai DM. (2009) Cost-effectiveness of misoprostol and prenatal iron mentation as maternal mortality interventions in home births in rural India, March 2009 in print ve rsion of International Journal of Obstetrics and Gynecology, Jan 2009 in electronic pre MAIN MESSAGES:
 Our research shows that the administration of misoprostol to prevent postpartum haemorrhage is cost effective and safe when used appropriately.  The use of misoprostol to prevent maternal deaths at home, in the absence of emergency obstetric care, could prevent many deaths in developing countries and take us nearer the realisation of Millennium Development Goal 5.  Based on the evidence Ministries of Health should introduce misoprostol for post-partum haemorrhage prevention and train providers in its safe administration. This should be supported by international development funders. A learning approach should be taken to  The potential use of misoprostol for termination of pregnancy should not be seen as a barrier to the implementation of interventions using misoprostol to prevent death due to post partum haemorrhage. An estimated 15% of maternal deaths are due to unsafe abortion. Efforts should be made to provide safe abortion services where the law allows it and reform legislative structures that force women to seek unsafe abortion. The authors express their appreciation for the financial support (Grant # H050474) provided by the UK Department for International Development (DFID) for the Future Health Systems research programme consortium. This document is an output from a project funded by DFID for the benefit of developing countries. The views expressed are not necessarily those of DFID. FUTURE HEALTH SYSTEMS
RESEARCH IN FOCUS

Source: http://www.eldis.org/vfile/upload/1/document/0903/roleofmisoprostol_safehomebirths1.pdf