SynthesisBulletin of the World Health Organization2009
Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects.
Synthesis in Bulletin of the World Health Organization, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 5 syntheses or guidelines pooled it, 105 citations in OpenAlex.
- Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews.Systematic reviews · 2018Pooled it
- Treatment for primary postpartum haemorrhage.The Cochrane database of systematic reviews · 2014Pooled it
- Postpartum misoprostol for preventing maternal mortality and morbidity.The Cochrane database of systematic reviews · 2013Pooled it
- Prostaglandins for preventing postpartum haemorrhage.The Cochrane database of systematic reviews · 2012Pooled it
- What measured blood loss tells us about postpartum bleeding: a systematic review.BJOG : an international journal of obstetrics and gynaecology · 2010Pooled it
- Randomized controlled trial comparing 400μg sublingual misoprostol versus placebo for prevention of primary postpartum hemorrhage.The Pan African medical journal · 2020Trial
- Trial
- Effectiveness and safety of misoprostol distributed to antenatal women to prevent postpartum haemorrhage after child-births: a stepped-wedge cluster-randomized trial.BMC pregnancy and childbirth · 2015Trial
- Oral misoprostol for preventing postpartum haemorrhage in home births in rural Bangladesh: how effective is it?Global health action · 2011Trial
- Sublingual misoprostol vs. oral misoprostol solution for induction of labor: A retrospective study.Frontiers in surgery · 2022Article
- Randomised Controlled Trial of Sublingual and Rectal Misoprostol in the Prevention of Primary Postpartum Haemorrhage in a Resource-Limited Community.Journal of obstetrics and gynaecology of India · 2020Article
- The impact of covariance priors on arm-based Bayesian network meta-analyses with binary outcomes.Statistics in medicine · 2020Article
- Induction of labour in nulliparous women- quick or slow: a cohort study comparing slow-release vaginal insert with low-dose misoprostol oral tablets.BMC pregnancy and childbirth · 2020Article
- Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all.BMJ global health · 2018Review
- Sublingual misoprostol and hyperpyrexia: case report with temperature curve.BMC research notes · 2017Article
- Acute complete uterine inversion after controlled cord traction of placenta following vaginal delivery: a case report.Clinical case reports · 2016Article
- The Effect of Combined Oxytocin-Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study.Journal of obstetrics and gynaecology of India · 2015Article
- Evaluation of inconsistency in networks of interventions.International journal of epidemiology · 2013Article
- Efficacy of rectal misoprostol for prevention of postpartum hemorrhage.Iranian journal of pharmaceutical research : IJPR · 2013Article
- Prevention of post-partum hemorrhage by rectal Misoprostol: A randomized clinical trial.Journal of natural science, biology, and medicine · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo review maternal deaths and the dose-related effects of misoprostol on blood loss and pyrexia in randomized trials of misoprostol use for the prevention or treatment of postpartum haemorrhage.
methodsWe searched the Cochrane Controlled Trials Register and Pubmed, without language restrictions, for '(misoprostol AND postpartum) OR (misoprostol AND haemorrhage) OR (misoprostol AND hemorrhage)', and we evaluated reports identified through the Cochrane Pregnancy and Childbirth Group search strategy. Randomized trials comparing misoprostol with either placebo or another uterotonic to prevent or treat postpartum haemorrhage were checked for eligibility. Data were extracted, tabulated and analysed with Reviewer Manager (RevMan) 4.3 software.
findingsWe included 46 trials with more than 40,000 participants in the final analysis. Of 11 deaths reported in 5 trials, 8 occurred in women receiving >or= 600 microg of misoprostol (Peto odds ratio, OR: 2.49; 95% confidence interval, CI: 0.76-8.13). Severe morbidity, defined as the need for major surgery, admission to intensive care, organ failure or body temperature >or= 40 degrees C, was relatively infrequent. In prevention trials, severe morbidity was experienced by 16 of 10,281 women on misoprostol and by 16 of 10,292 women on conventional uterotonics; in treatment trials, it was experienced by 1 of 32 women on misoprostol and by 1 of 32 women on conventional uterotonics. Misoprostol recipients experienced more adverse events than placebo recipients: 8 of 2070 versus 5 of 2032, respectively, in prevention trials, and 5 of 196 versus 2 of 202, respectively, in treatment trials. Meta-analysis of direct and adjusted indirect comparisons of the results of randomized trials showed no evidence that 600 microg are more effective than 400 microg for preventing blood loss > 1000 ml (relative risk, RR: 1.02; 95% CI: 0.71-1.48). Pyrexia was more than twice as common among women who received > 600 microg rather than 400 microg of misoprostol (RR: 2.53; 95% CI: 1.78-3.60).
conclusionFurther research is needed to more accurately assess the potential beneficial and harmful effects of misoprostol and to determine the smallest dose that is effective and safe. In this review, 400 microg of misoprostol were found to be safer than > 600 microg and just as effective.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.