Abstract
BackgroundMeta-analyses of postpartum blood loss and the effect of uterotonics are biased by visually estimated blood loss.ObjectivesTo conduct a systematic review of measured postpartum blood loss with and without prophylactic uterotonics for prevention of postpartum haemorrhage (PPH).Search strategyWe searched Medline and PubMed terms (labour stage, third) AND (ergonovine, ergonovine tartrate, methylergonovine, oxytocin, oxytocics or misoprostol) AND (postpartum haemorrhage or haemorrhage) and Cochrane reviews without any language restriction.Selection criteriaRefereed publications in the period 1988–2007 reporting mean postpartum blood loss, PPH (≥500 ml) or severe PPH (≥1000 ml) following vaginal births.Data collection and analysisRaw data were abstracted into Excel by one author and then reviewed by a co-author. Data were transferred to SPSS 17.0, and copied into RevMan 5.0 to perform random effects meta-analysis.Main resultsThe distribution of average blood loss (29 studies) is similar with any prophylactic uterotonic, and is lower than without prophylaxis. Compared with no uterotonic, oxytocin and misoprostol have lower PPH (OR 0.43, 95% CI 0.23–0.81; OR 0.73, 95% CI 0.50–1.08, respectively) and severe PPH rates (OR 0.61, 95% CI 0.29–1.29; OR 0.74, 95% CI 0.52–1.04, respectively). Oxytocin has lower PPH (OR 0.65, 95% CI 0.60–0.70) and severe PPH (OR 0.71, 95% CI 0.56–0.91) rates than misoprostol, but not in developing countries.ConclusionOxytocin is superior to misoprostol in hospitals. Misoprostol substantially lowers PPH and severe PPH. A sound assessment of the relative merits of the two drugs is needed in rural areas of developing countries, where most PPH deaths occur.
Highlights
Haemorrhage is the single leading cause of maternal mortality.[1]
The highest average blood loss was among women managed without uterotonic prophylaxis
The range of average blood loss was similar in women receiving any prophylactic uterotonic: 151–499 ml for oxytocin, 155–443 ml for misoprostol, and 149–476 ml in women receiving ergometrine
Summary
Haemorrhage is the single leading cause of maternal mortality.[1] Postpartum haemorrhage (PPH) is most often attributed to uterine atony.[2] Most births and maternal deaths occur in Africa and Asia, where home deliveries are common, infrastructure and transportation are limited, and where birth attendants are scarce or inadequately prepared to prevent and treat PPH.[3] In such settings haemorrhage accounts for ‡30% of maternal deaths.[1] The United Nation’s Millennium Development goal 5, to reduce 75% of maternal mortality by 2015, cannot be reached without the successful management of PPH.[4,5]. Meta-analyses of postpartum blood loss and the effect of uterotonics are biased by visually estimated blood loss
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
