C Langenbach1. 1. Epidemiology and Biostatistics, School of Public Health, University of California at Berkeley, CA, USA. colangenbach@yahoo.com
Abstract
OBJECTIVE: To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world. METHOD: Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics. RESULT: This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug. CONCLUSION: Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all.
OBJECTIVE: To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world. METHOD: Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics. RESULT: This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug. CONCLUSION: Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all.
Authors: Stacie E Geller; Shivaprasad S Goudar; Marci G Adams; Vijaya A Naik; Ashlesha Patel; Mrutyunjaya B Bellad; Shobhana S Patted; Stanley A Edlavitch; Nancy Moss; Bhalchandra S Kodkany; Richard J Derman Journal: Int J Gynaecol Obstet Date: 2008-03-04 Impact factor: 3.561
Authors: Dietmar Schlembach; Hanns Helmer; Wolfgang Henrich; Christian von Heymann; Franz Kainer; Wolfgang Korte; Maritta Kühnert; Heiko Lier; Holger Maul; Werner Rath; Susanne Steppat; Daniel Surbek; Jürgen Wacker Journal: Geburtshilfe Frauenheilkd Date: 2018-04-26 Impact factor: 2.915