Abstract
During the past decade, The Lancet has led the debate over the use of misoprostol for prevention of postpartum haemorrhage. A letter published in 1996 first suggested the use of misoprostol for the third stage of labour.1 Here was a drug that seemed perfectly designed to reduce blood loss in childbirth. Misoprostol is an inexpensive heat-stable prostaglandin E1 analogue with strong uterotonic activity that can be given without the need for sterile needles and syringes. Huge interest was generated and, in the ensuing 10 years, more than 30 randomised trials in more than 30 000 women2 were done to study misoprostol for prophylaxis of postpartum haemorrhage.
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