Misoprostol for preventing and treating postpartum hemorrhage in the community: a closer look at the evidence.

The lack of clear interpretation of clinical and operational evidence on misoprostol use for postpartum hemorrhage (PPH) in the community may jeopardize the realization of its full potential for improving women's survival. This paper highlights the usefulness of misoprostol in addressing PPH in the community within the limits of available research evidence. There is now substantial evidence to support the beneficial effects of 600 μg of oral misoprostol for PPH prevention in the community, with a trend toward better protection against severe PPH morbidity, and particularly when administered by less skilled or lay caregivers. Although there is tangible evidence to show that 800 μg of sublingual misoprostol has important benefits for PPH treatment where there is no access to oxytocin, there is presently no direct evidence to indicate that less skilled or lay caregivers can safely use it to treat PPH in the community. Operational research evidence indicates that advance community distribution of misoprostol to pregnant women for postpartum self-use is a feasible strategy to ensure availability of the drug at the time of birth. The evidence is, however, limited by its quality to establish whether the benefits of such a strategy truly outweigh the potential harms. It is time for the international community to focus on improving PPH-related outcomes by scaling up what is currently guided by hard evidence and join forces to address unanswered questions through high-quality research.