Misoprostol vs. Oxytocin for Postpartum Hemorrhage When Clinical Resources Are Scarce

Postpartum hemorrhage is a key contributor to maternal morbidity and mortality in developing countries. Standard treatment for this obstetrical emergency is oxytocin; however, the drug requires refrigeration and intravenous administration, and thus might not be readily available in resource-poor settings. Misoprostol is also uterotonic, is easy to store, and can be administered sublingually. In two double-blind randomized trials conducted in Egypt, Vietnam, Ecuador, Burkina Faso, and Turkey, investigators assessed the effect of 800-µg sublingual misoprostol on postpartum hemorrhage (defined as blood loss >700 mL) compared with that of 40-IU intravenous oxytocin.

The first study involved 978 women who had not received oxytocin during labor. A…