Misoprostol for the treatment of postpartum hemorrhage

Abstract

Sir , We thank Olufowobi et al. for their interest in our paper and we hope to answer their questions below. Our study on the treatment of postpartum hemorrhage was a pragmatic trial where the midwives assessed blood loss clinically through visual estimation. As yet, neither visual nor laboratory estimation of blood loss have shown to be better than the other at quantification (1). The intravenous infusions were set up as a matter of urgency by the labor ward staff on duty once primary postpartum hemorrhage was diagnosed. However, no record of the precise time it took to set up the infusion was kept because the primary outcome measure was cessation of hemorrhage 20 min after drug administration rather than estimated blood loss. Olufowobi et al. have reasonably calculated that we could have recruited all of the patients in 1 year. However, recruitment was slow because conducting clinical trials in low-resource settings are difficult as essential medical services are often very over stretched. Side-effects of misoprostol such as shivering almost reached statistical significance. Perhaps a larger study would have reached significance for some of the other side-effects, but as these parameters were secondary outcomes measures, we did not recruit to prove a difference here. In our study, we aimed to compare a new regimen with the standard local regimen, which determined the oxytocin infusion concentration. It must be noted that ergometrine was also part of the local regimen. We would welcome a further study using a higher oxytocin concentration. However, in a low-resource setting with high HIV rates, a rectal preparation would seem easier to administer and because of reduced need for intravenous cannulation. We believe the findings of this study will eventually lead to the availability of this treatment in rural clinics, which have little or no medical equipment for the treatment of postpartum hemorrhage.