Inexpensive Drug Can Prevent Postpartum Hemorrhage

Deaths from postpartum hemorrhage, excessive bleeding by the mother after giving birth, are rare in developed countries like the U.S., where the majority of births occur in hospitals and emergency care is available. But the condition can be life-threatening in countries where most births occur at home and emergency care may not be available. Researchers have now found that the drug misoprostol provides a safe, convenient and inexpensive way to prevent this major killer of women in developing countries.

Postpartum hemorrhage is caused by the uterus failing to contract after the placenta detaches, or by ruptures or tears in the uterus and other tissues. In developed countries, oxytocin is the standard drug used to prevent postpartum hemorrhage. It stops bleeding in the uterus by causing it to contract. But oxytocin needs to be kept cold and must be given by trained medical personnel, so it's not ideal for use in developing countries.

The drug misoprostol also stops uterine bleeding by causing the uterus to contract, but it doesn't require refrigeration and doesn't have to be given by highly trained personnel. It's taken once after delivery as three tablets costing as little as 14 cents each. Researchers from the University of Missouri, India's Jawaharlal Nehru Medical College and NIH set out to see if misoprostol could provide an effective way to prevent postpartum hemorrhage in countries where hospital services are in limited supply. Their work was funded by the Global Network for Women's and Children's Health Research, a public-private partnership between NIH's National Institute of Child Health and Human Development (NICHD) and the Bill and Melinda Gates Foundation.

Between September, 2002 and December 2005, the researchers recruited 25 nurse midwives who serve the rural villages of the Belgaum District in Karnataka State. The midwives were shown how to administer misoprostol and how to measure blood loss following birth using a plastic drape specifically designed for the study. Women who volunteered to participate were assigned at random to receive either misoprostol or an identical looking but inactive placebo immediately after they gave birth. Neither the midwives nor the women knew who received misoprostol and who received the placebo.

The researchers reported in the October 7, 2006 issue of Lancet that only 6.4% of the women receiving misoprostol had acute postpartum hemorrhage, compared with 12% in the placebo group. Misoprostol significantly reduced the average blood loss of women who received the drug. Side effects included a modest increase in shivering and fever. The infants of nursing mothers who took misoprostol showed no side effects.

Dr. Nancy Moss, the NICHD author and project officer for the study, said “We now have proven that misoprostol is a convenient, inexpensive, safe and effective drug to lessen a major cause of death of women in the developing world — postpartum hemorrhage.”

Another benefit from the study was the development of the drape to estimate blood loss. Before this trial, the midwives had no way to accurately estimate blood loss. The drape provided an accurate, easy-to-use and inexpensive (about $1.00 each) way to collect and measure blood. Wider use of the device could lead to earlier detection of postpartum hemorrhage and earlier interventions to save lives.