Misoprostol (Cytotec) was originally developed for treating gastric ulcers. However, the drug is increasingly being given to women during labor in low- and middle-income countries to prevent postpartum hemorrhage (PPH).
Although misoprostol is included on the World Health Organization’s Essential Medicines List for this use, a study published in the Journal of the Royal Society of Medicine, states that there is insufficient evidence of the drugs effectiveness.
Researchers led by Professor Allyson Pollock from the Center for Primary Care and Public Health at Queen Mary, University of London (UK), examined 172 studies on the use of misoprostol during labor and only found that 6 contained sufficient information to enable them to review whether the drug was effective in preventing PPH.
According to the researchers, all six of the studies were unable to provide enough evidence that misoprostol was effective. In addition, the team found that there were problems in the majority of the study designs and that the findings were not applicable generally.
Professor Pollock, explained:
“Current evidence to support the use of misoprostol in home or community settings in low- and middle-income countries for the prevention of postpartum hemorrhage is, at best, inconclusive.
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.”
In 2008, there were 342,900 deaths associated to pregnancy and childbirth, according to WHO estimates, with the majority of deaths occurring in developing nations. Up to 25% of these deaths are believed to be associated with PPH while giving birth.
Anemia is the primary risk factor for PPH, and can be easily treated if it is diagnosed. However, without antenatal screening for anemia it is impossible to identify those who have developed anemia and women that are more likely to experience life-threatening bleeding during childbirth.
Professor Pollock explained:
“The most effective preventive strategy for PPH is prevention of anemia, good antenatal care including good hygiene and sanitation and good care during labour. Developed countries would not dream of giving women misoprostol during labor on the basis of the current evidence, yet industry and health practitioners are pushing it hard in developing countries.”
One reason for its popularity in developing nations is that it does not degrade if not kept in cold storage conditions, and that it does not have to be given intravenously. Due to this, the drug is more likely to be used outside hospitals, in settings such as the home and local community when women go into labor.
Professor Pollock concluded: “Countries should be concentrating on improving their primary care facilities, rather than thinking there is a pill to prevent every ill. 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.”
Written by Grace Rattue