No evidence that drug used for preventing life-threatening bleeding in women during labor works
There is insufficient evidence for the effectiveness of a drug that is being used increasingly to prevent life-threatening bleeding in women after giving birth in community settings in low income countries, according to a review of all the available research published today (Monday) in the Journal of the Royal Society of Medicine.
Misoprostol (brand name Cytotec) was originally developed for treating gastric ulcers, but is increasingly used in low- and middle-income countries for preventing postpartum haemorrhage (PPH). It is given to women during labour to prevent uncontrolled bleeding, and it is included on the World Health Organisation's Essential Medicines List for this use.
However, researchers led by Professor Allyson Pollock from the Centre for Primary Care and Public Health at Queen Mary, University of London (UK) identified 172 studies on the use of misoprostol during labour and found that only six had enough information to enable them to review whether or not 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 and the fact the findings were not applicable generally.
"Current evidence to support the use of misoprostol in home or community settings in low- and middle-income countries for the prevention of postpartum haemorrhage is, at best, inconclusive," said Professor Pollock.
"Yet, despite there being no proper evidence of benefit, the WHO and some countries have put it on the Essential Medicine Lists and the drug is being pushed hard by networks of global public-private partnerships and industry in low- and middle-income countries. Countries such as Nepal, India and Uganda are promoting and using it. We urge the WHO to urgently review its decision to put misoprostol on its Essential Medicines List."
According to WHO estimates, there were 342,900 deaths related to pregnancy and childbirth in 2008, most of them occurring in developing countries. A quarter of these are thought to be associated with PPH while giving birth.
The main risk factor for PPH is anaemia, which is easily treated if it is diagnosed. But without antenatal screening for the condition it is impossible to identify women who may have developed it and who are at increased risk of life-threatening bleeding during labour.
"The most effective preventive strategy for PPH is prevention of anaemia, good antenatal care including good hygiene and sanitation and good care during labour," said Professor Pollock. "Developed countries would not dream of giving women misoprostol during labour on the basis of the current evidence, yet industry and health practitioners are pushing it hard in developing countries."
One of the reasons that misoprostol is popular in developing countries is that it is a fairly stable drug that doesn't degrade if not kept in cold storage conditions, and which does not have to be given intravenously. For this reason, it is more likely to be used outside hospitals, in settings such as the home and local community when women go into labour.
"Countries should be concentrating on improving their primary care facilities, rather than thinking there is a pill to prevent every ill," said Professor 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."
More information: "Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage", by Christina Chu, Petra Brhlikova and Allyson Pollock. Journal of the Royal Society of Medicine 2012: 105: 336-347. doi 10.1258/jrsm.2012.120044.
Journal reference: Journal of the Royal Society of Medicine
Provided by Queen Mary, University of London
- Simplified approach to preventing post-birth bleeding appears safe and effective Mar 05, 2012 | not rated yet | 0
- Growing danger from post-birth bleeding Feb 25, 2009 | not rated yet | 0
- Misoprostol substantially reduces serious complications in early termination of pregnancy Mar 07, 2012 | not rated yet | 0
- Obesity linked to economic status in developing countries Jul 18, 2012 | not rated yet | 0
- Fewer iron supplements during pregnancy work just as well for preventing anemia Jul 10, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Absorption of light by spherical nanoparticle
3 hours ago Hello Can anyone tell me how the absorption of a polystyrene nanoparticles scales as a function of its diameter. The particle is spherical and...
Solvability of a circuit
8 hours ago Let's say I have a circuit consisting only of a finite number of batteries and resistors, all ideal. Given an arbitrary shape of this circuit, will I...
Question about perception of colors around light sources
11 hours ago When I look at a distant light source (like car headlights, or street lamp lights) I notice colors of the visible spectrum (as separated (as in after...
Does a charged particle rotate when traveling through a static Bf?
13 hours ago I have been looking at mass spectrometers, in particular the interactions between the Bf ind of a charged particle in motion in a static Bf of the...
Find a link between physics and assignment problems
14 hours ago Hi ! I've been working about assignments problems and how to solve them. I will have to do a presentation about it in few weeks. However, I'll...
Light as a source of electricity
14 hours ago Hello Dear Fellows! We all know that light is an electromagnetic wave and also we know that an antenna receives EM waves and...
- More from Physics Forums - Classical Physics
More news stories
New research indicates that women's reproductive function may be tied to their immune status. Previous studies have found this association in human males, but not females.
Obstetrics & gynaecology May 17, 2013 | not rated yet | 0 |
Elsevier today announced the publication of a recent study in Reproductive BioMedicine Online on 5-day old human blastocysts showing that those with an abnormal chromosomal composition can be identified by the rate at whic ...
Obstetrics & gynaecology May 16, 2013 | not rated yet | 0
While global attention has for decades been focused on reducing maternal mortality, population-based data on other causes of death among women of reproductive age has been virtually non-existent. A study conducted by researchers ...
Obstetrics & gynaecology May 14, 2013 | not rated yet | 0
Doctors have terminated the pregnancy of a 23-year-old Turkish woman who was the first ever to receive a uterus transplant from a dead donor, a hospital in southern Turkey said on Tuesday.
Obstetrics & gynaecology May 14, 2013 | not rated yet | 0
Whole-cell pertussis vaccines were more effective at protecting against pertussis than acellular pertussis vaccines during a large recent outbreak, according to a new Kaiser Permanente study published in Pediatrics.
1 hour ago | not rated yet | 0 |
Optimal treatment of sleep apnea in patients with prediabetes improves blood sugar (glucose) levels and thus can reduce cardiometabolic risk, according to a study to be presented at the ATS 2013 International Conference in ...
49 minutes ago | not rated yet | 0 |
Researchers at Mayo Clinic have developed a promising method to distinguish between pancreatic cancer and chronic pancreatitis—two disorders that are difficult to tell apart. A molecular marker obtained from pancreatic ...
1 hour ago | not rated yet | 0
A new measure of the heterogeneity – the variety of genetic mutations – of cells within a tumor appears to predict treatment outcomes of patients with the most common type of head and neck cancer. In the May 20 issue ...
49 minutes ago | not rated yet | 0
Emergency physicians are key decisionmakers for nearly half of all hospital admissions, highlighting a critical role they can play in reducing health care costs, according to a new report from the RAND Corporation.
39 minutes ago | not rated yet | 0
A novel study reports that white men and women of European descent inherit common foot disorders, such as bunions (hallux valgus) and lesser toe deformities, including hammer or claw toe. Findings from the Framingham Foot ...
1 hour ago | not rated yet | 0 |