A Systematic Review on the Effect of Misoprostol in the Prevention of Postpartum Hemorrhage in Sub-Saharan African Women of Reproductive Age

Abstract

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Oxytocin is the uterotonic drug of choice to prevent PPH. This systematic review was performed to evaluate the use of misoprostol as a possible alternative in resource-poor settings. Articles were selected on PubMed and the International Journal of Obstetrics and Gynecology based on their primary outcomes (estimated blood loss (EBL) in mL), region (Sub-Saharan Africa) and purpose (comparing (1) misoprostol with oxytocin or with a controlled placebo (2) and different doses of misoprostol). All meta-analyses used a Cohen’s D scale. There was no difference between the use of oxytocin over misoprostol and meta-analysis shows that when used separately, both medications decreased total EBL. Misoprostol at 400 and 600 mcg did not show any difference on EBL compared to oxytocin. In combination with oxytocin, there was no difference on EBL compared to misoprostol alone. When oxytocin was not added to misoprostol, there also was no difference on EBL compared to misoprostol alone. This study suggests that misoprostol may be a sustainable alternative to prevent PPH in resource-poor areas where oxytocin is unavailable.