Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial

Gijs Walraven, Secretariat de Son Altesse l'Aga Khan
Jennifer Blum, Population Council
Yusupha Dampha, Medical Research Laboratories
Maimuna Sowe, Medical Research Laboratories
Linda Morison, London School of Hygiene and Tropical Medicine
Nancy Sloan, Population Council
Beverly Winikoff, Gynuity Health Projects

PPH is a major cause of maternal deaths. This RCT examined the impact of oral misoprostol on PPH and anaemia as compared to standard active management in rural Gambia. Each woman delivering at home with a study birth attendant and who gave informed consent was randomly assigned 600 µg misoprostol and placebo, or placebo and 2 mg ergometrine (standard treatment). Tablets were taken orally immediately after delivery. Measured blood loss >= 500 ml was 11.0% with misoprostol and 12.0% with ergometrine (69/629 vs 72/599; RR 0.90; 95% CI 0.64-1.28), and postpartum Hb<8 gr/dL was 19.8% with misoprostol and 23.1% with ergometrine (124/626 vs 138/598; 0.82,0.63-1.08). Postpartum >= Hb 2gr/dL lower than pre-delivery was 16.2% with misoprostol and 21.8% with ergometrine (99/610 vs 128/588; 0.70,0.52-0.93), and there was a trend to reduced blood loss >= 750 mls with misoprostol (9/629 vs 13/599; 0.65,0.28-1.54). No severe side effects were noted.