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No Evidence That Misoprostol (Cytotec) Prevents Life-Threatening Bleeding in Women During Labor
There is insufficient evidence for the effectiveness of a drug that is being used increasingly to prevent life-threatening bleeding in women who give birth in community settings in low-income countries, according to a review published on August 20 in the Journal of the Royal Society of Medicine.
Misoprostol (Cytotec) was originally developed for treating gastric ulcers but is increasingly used in low- and middle-income countries for preventing postpartum hemorrhage (PPH). The drug is given to women during labor to prevent uncontrolled bleeding, and it is included on the Essential Medicines List of the World Health Organization (WHO) for that use.
However, researchers at Queen Mary College, University of London, identified 172 studies on the use of misoprostol during labor and found that only six had enough information to enable them to review whether the drug was effective in preventing PPH in rural and community settings in low-income countries. The six studies failed to provide sufficient evidence that the drug worked, and most had problems with study design.
According to WHO estimates, 342,900 deaths related to pregnancy and childbirth occurred in 2008, most of them in developing countries. A quarter of these deaths are thought to be associated with PPH while giving birth.
Misoprostol is popular in developing countries because it is a fairly stable drug that doesn’t degrade if it is not kept in cold-storage conditions, and because it does not have to be given intravenously. For these reasons, misoprostol is more likely to be used outside hospitals, in settings such as the home and local community when women go into labor.
“Countries should be concentrating on improving their primary care facilities, rather than thinking there is a pill to prevent every ill,” said lead researcher Professor Allyson Pollock. “Misoprostol is being used inappropriately at present, and the money being spent on purchasing the drug would be better spent elsewhere — for instance, in ensuring there are skilled attendants during delivery and adequate antenatal services that can detect and help to prevent complications.”
For more information, visit the Queen Mary Web site.