Evidence map›Paper›PMID 26333044›Full record

Trial reportBJOG : an international journal of obstetrics and gynaecology2016

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster-randomised non-inferiority community trial.

S Raghavan, S Geller, S Miller, S S Goudar, H Anger, M C Yadavannavar, R Dabash, S R Bidri, M R Gudadinni, R Udgiri and 3 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BJOG : an international journal of obstetrics and gynaecology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 4 pooled it
8.6field-weighted citation impact, top 3% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 35 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 2 countries.

S RaghavanGynuity Health Projects, New York, NY, USA.
S GellerUniversity of Illinois at Chicago, Chicago, IL, USA.
S MillerUniversity of California, San Francisco, CA, USA.
S S GoudarKLE University's Jawaharlal Nehru Medical College, Belgaum, India.
H AngerGynuity Health Projects, New York, NY, USA.
M C YadavannavarBLDE University's Sri B. M. Patil Medical College, Bijapur, India.
R DabashGynuity Health Projects, New York, NY, USA.
S R BidriBLDE University's Sri B. M. Patil Medical College, Bijapur, India.
M R GudadinniBLDE University's Sri B. M. Patil Medical College, Bijapur, India.
R UdgiriBLDE University's Sri B. M. Patil Medical College, Bijapur, India.
A R KochUniversity of Illinois at Chicago, Chicago, IL, USA.
M B BelladKLE University's Jawaharlal Nehru Medical College, Belgaum, India.
B WinikoffGynuity Health Projects, New York, NY, USA.
Gynuity Health Projects · USBLDE University · INShri BM Patil Medical College · INUniversity of Illinois Chicago · USJawaharlal Nehru Medical College · INKLE University · INUniversity of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess whether secondary prevention, which preemptively treats women with above-average postpartum bleeding, is non-inferior to universal prophylaxis.

designA cluster-randomised non-inferiority community trial.

settingHealth sub-centres and home deliveries in the Bijapur district of Karnataka, India. POPULATION: Women with low-risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub-centre and who consented to be part of the study.

methodsAuxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour.

main outcome measuresPostpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher-level facilities, acceptability and feasibility of the intervention.

resultsMisoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference -2.9%, one-sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013).

conclusionSecondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level. TWEETABLE ABSTRACT: Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis.

Indexed as

Administration, OralAdultCluster AnalysisFeasibility StudiesFemaleHome ChildbirthHumansIndiaMidwiferyMisoprostolOxytocicsPostpartum HemorrhagePregnancyPrimary PreventionSecondary PreventionMisoprostolOxytocicsMisoprostolpostpartum haemorrhageprimary preventionsecondary prevention

Identifiers

PMID26333044
PMCPMC5014137
OpenAlexW1567312855

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.