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Treatment for primary postpartum haemorrhageMousa HA, Alfirevic Z
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SummaryTreatment for primary postpartum haemorrhage needs more researchAfter a woman gives birth, womb muscles contract, clamping down on the blood vessels and helping to limit bleeding when the placenta has detached. If the muscles do not contract strong enough, postpartum haemorrhage (very heavy bleeding) can occur, which can be life-threatening. These situations are common in resource-poor countries, and maternal mortality is about one hundred times higher than in resource-rich countries. It is a serious problem that requires effective treatments which might avert the use of surgery to remove the womb (hysterectomy), often the last treatment option. The earlier treatment options include drugs to increase muscle contractions (such as ergometrine, oxytocin and prostaglandins), surgical techniques (such as tying off or blocking the uterine artery), radiological interventions (such as blocking of the main artery to the womb using gel foams), and haemostatic drugs (such as tranexamic acid and recombinant activated factor VII). The review identified three trials involving 462 women that assessed treatment with the drug misoprostol, but there were no trials about the effects of surgical techniques, radiological interventions or haemostatic drugs. One small trial showed a possible benefit of rectal misoprostol compared with standard combination of ergometrine and oxytocin. However, more research is needed before newer drugs, like misoprostol, can be tried as a first-line drug treatment to be sure that maternal mortality is not increased and to further assess the possible impact of adverse side-effects like shivering, nausea and headaches.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 20. 2003 AbstractBackgroundPrimary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries. ObjectivesTo assess the effectiveness and safety of pharmacological, surgical and radiological interventions used for the treatment of primary PPH. Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2006). Selection criteriaRandomised controlled trials comparing pharmacological, surgical techniques and radiological interventions for the treatment of PPH. Data collection and analysisWe assessed studies for eligibility and quality, and extracted data, independently. We contacted authors of the included studies for more information. Main resultsThree studies (462 participants) were included. Two placebo-controlled randomised trials compared misoprostol (dose 600 to 1000 mcg) with placebo and showed that misoprostol use was not associated with any significant reduction of maternal mortality (two trials, 398 women; relative risk (RR) 7.24, 95% confidence interval (CI) 0.38 to 138.6), hysterectomy (two trials, 398 women; RR 1.24, 95% CI 0.04 to 40.78), the additional use of uterotonics (two trials, 398 women; RR 0.98, 95% CI 0.78 to 1.24), blood transfusion (two trials, 394 women; RR 1.33, 95% CI 0.81 to 2.18), or evacuation of retained products (one trial, 238 women; RR 5.17, 95% CI 0.25 to 107). Misoprostol use was associated with a significant increase of maternal pyrexia (two trials, 392 women; RR 6.40, 95% CI 1.71 to 23.96) and shivering (two trials, 394 women; RR 2.31, 95% CI 1.68 to 3.18). One unblinded trial showed better clinical response to rectal misoprostol compared with a combination of syntometrine and oxytocin. We did not identify any trial dealing with surgical techniques, radiological interventions or haemostatic drugs for women with primary PPH unresponsive to uterotonics. Authors' conclusionsThere is insufficient evidence to show that the addition of misoprostol is superior to the combination of oxytocin and ergometrine alone for the treatment of primary PPH. Large multi-centre, double-blind, randomised controlled trials are required to identify the best drug combinations, route, and dose of uterotonics for the treatment of primary PPH. Further work is required to assess the best way of managing women who fail to respond to uterotonics therapy. |
