International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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A literature review was conducted to determine whether misoprostol is an effective treatment for postpartum hemorrhage (PPH) and in what dose. All English language articles published before March 2007 reporting on misoprostol for treatment of PPH were reviewed. ⋯ Nonetheless, PPH remains a major killer of women worldwide, and new treatment options are widely sought. For this reason, we recommend a single dose of misoprostol 600 microg oral or sublingual for PPH treatment in instances when other treatments have either failed to work or are not available.
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Int J Gynaecol Obstet · Dec 2007
ReviewMisoprostol: pharmacokinetic profiles, effects on the uterus and side-effects.
Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming, the management of miscarriage, induction of labor and the management of postpartum hemorrhage. It can be given orally, vaginally, sublingually, buccally or rectally. ⋯ These studies can help to discover the optimal dose and route of administration of misoprostol for individual clinical applications. Misoprostol is a safe drug but serious complications and teratogenicity can occur with unsupervised use.
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As a stable, orally active and cheap uterotonic, misoprostol would appear ideally suited to the prevention of postpartum hemorrhage (PPH) in the developing world. Following numerous clinical trials, it appears that misoprostol prophylaxis using an oral or sublingual dose of 600 microg is more effective than placebo at preventing PPH in community births (relative risk 0.59, 95% confidence intervals 0.41-0.84), but not in hospital settings (RR 1.23, 95% CI 0.86-1.74). ⋯ In the event of continued hemorrhage, a minimum of 2 h should lapse after the original dose before a second dose is given. If the initial dose was associated with pyrexia or marked shivering, at least 6 h should lapse before the second dose is given.