Conclusions
First-line treatment with 600mcg of sublingual misoprostol, preceded by the intramuscular provision of 10 IU of oxytocin, works well in controlling hemorrhage and minimizing the occurrence of high fever among Ecuadorian women. The lower misoprostol dose offers a potential solution for treating PPH in communities known to be more susceptible to higher rates of misoprostol's thermoregulatory effects. However, these findings do not provide conclusive evidence of misoprostol's efficacy using this lower dose. Moreover, there is no evidence that this dosage alone in the absence of oxytocin prophylaxis would be an effective intervention for controlling PPH and avoiding side effects. Until additional information becomes available on the effectiveness of lower dosages, the evidence-based 800mcg sublingual regimen is recommended, particularly in settings where the provision of intravenous oxytocin is not feasible.[1,2] Operations research utilizing the 800mcg sublingual regimen in other settings is recommended to confirm the safety and acceptability of this approach to manage cases of PPH. If indeed unusually high rates of elevated body temperature are documented among other populations, future research on the efficacy of lower dosages for treating PPH may be justified.
Authors' contributions
WL: contributed to the conception of the trial, participated in its implementation and interpretation of the trial findings, and helped draft the manuscript. JD: contributed to the conception of the trial, provided clinical monitoring, analyzed the study findings and drafted the manuscript. GB: participated in the study implementation and interpretation of results. EP: participated in the study implementation, managed the data collected, and participated in the interpretation of result. BW: contributed to the conception of the trial, helped interpret data and draft the manuscript. All authors read and approved the final manuscript.
Acknowledgements
The authors first and foremost thank the women who participated in this study and the hospital staff who attended to them in addition to collecting necessary data for this study in Quito: Catalina Jácome, María Caiza, Sonia Cajas and César Carvajal. We thank Dr. Humberto Navas, Dr. Rolando Montesinos and others authorities of the Maternity Hospital Isidro Ayora in Quito, Ecuador for their support. We also wish to acknowledge our Data Safety and Monitoring Board Members for their time and contributions. The authors also thank Ms. Jennifer Blum for reviewing this manuscript. This research was funded by a grant from the Bill and Melinda Gates Foundation. The Foundation had no role in the actual planning, writing or submission of this paper.
Abbreviation
PPH, Postpartum hemorrhage.
BMC Pregnancy Childbirth. 2012;12(65) © 2012 BioMed Central, Ltd.
