Effect of community-based distribution of misoprostol on facility delivery: a scoping review

Gizachew Tadele Tiruneh,Yibeltal Tebekaw Bayou,Wubegzier Mekonnen Ayele,Meselech Assegid Roro,Muluneh Yigzaw,Araya Abrha Medhanyi,Etenesh Gebreyohannes Hailu,Bereket Yakob

doi:10.1186/s12884-019-2539-5

Abstract

IntroductionCommunity distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse.MethodsWe included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated.ResultsThree qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups [OR 1.011; 95% CI: 0.906–1.129]. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases.In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed.ConclusionsThe claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages, especially in resource-limited settings.

Highlights

Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage
More than two-thirds of maternal deaths due to hemorrhage occur during the postpartum period, which accounts for 20% of all maternal deaths in developing regions [5]
Evidence shows that most Postpartum Hemorrhage (PPH)-associated deaths could be avoided if active management of third stage of labor (AMTSL) is implemented [13], adverse outcomes and complications are prevented or managed using safe drugs in communities and facilities, and effective referral mechanisms are implemented during delivery and in the postpartum period [14]

Summary

Introduction

Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse. Evidence shows that most PPH-associated deaths could be avoided if active management of third stage of labor (AMTSL) is implemented [13], adverse outcomes and complications are prevented or managed using safe drugs in communities and facilities, and effective referral mechanisms are implemented during delivery and in the postpartum period [14]. Intravenous or intramuscular administration of uterotonics are the most essential component of AMTSL [15] and oxytocin remains the first choice uterotonics for the prevention of PPH [14]

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Results

Conclusion