Misoprostol for safe motherhood: one tablet, two life-saving indications

Abstract

Misoprostol is a safe, acceptable, feasible, and effective alternative for both postpartum hemorrhage (PPH) and the treatment of incomplete abortion and miscarriage when no other interventions are available, which is often the case in resource-challenged regions. This article reviews the use of misoprostol for these two leading causes of maternal death globally and presents data on the implementation of misoprostol for PPH in Zanzibar as a case study. An evaluation was conducted to assess the uptake of misoprostol in public facilities in Zanzibar through a record review at nine facilities on various indicators from April 2008 to March 2009. For comparison, pre-intervention data were also collected from the same nine facilities for the 12 months preceding the PPH management trainings in April 2008. Following the introduction of misoprostol for PPH, the need for additional interventions among PPH cases significantly declined. The post-intervention period showed significantly fewer blood transfusions, PPH referrals, and PPH-related maternal deaths. Among PPH cases, the need for blood transfusion decreased from 30 (19.2%) in the pre-intervention period to 7 (2.4%) in the postintervention period. Rates of PPH-related referrals and maternal deaths also declined from 7.7% pre-intervention to 3.1% postintervention (P<0.05). Misoprostol has the potential to make an immediate impact on the number of maternal deaths resulting from PPH and treatment of incomplete abortion and miscarriage.