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POSTPARTUM HEMORRHAGE
Prevention Treatment
400 mcg
Oral Vaginal Sublingual
misoprostol
Time to onset of
uterine activity 7.8 min 19.4 min 10.7 min
Time to maximum
uterine tonus 25-39 min 46-62 min 47-51 min
Danielsson et al., Obstet Gynecol, 1999; Aronsson et al., Hum Reprod, 2004
PHARMACOKINETICS OF
MISOPROSTOL
Dose Oral Sublingual Rectal Vaginal
Time to peak concentration (min)
400 mcg 28-34 26 60-80
600 mcg 18-20 41
Peak concentration (pg/ml)
400 mcg 227-288 575 125
600 mcg 328-381 184
AUC 4 hours (pg/hrs/mL)
400 mcg 273 503
600 mcg 190 311
AUC 6 hours (pg/hrs/mL)
400 mcg 300-403 744 434
PHARMACOKINETICS OF
MISOPROSTOL
Easy to transport
Treatment algorithm is
not clear
Easy to administer
Side effects
POSTPARTUM HEMORRHAGE
MANAGEMENT STRATEGY
Prevention Treatment
1606 women
PPH > 500 ml Miso > Oxy > Miso + Oxy > Meth + Oxy
PPH > 1000 ml Miso > Oxy > Miso + Oxy > Meth + Oxy
PPH > 500 ml Miso ~ Oxy > Miso + Oxy = Meth + Oxy
PPH > 1000 ml Miso ~ Oxy > Miso + Oxy = Meth + Oxy
Shivering NNH= 14
Fever > 38°C NNH= 38
Vomiting and diarrhea was comparable
Shivering NNH= 12
Fever > 38°C NNH= 31
Vomiting and diarrhea was comparable
•Postpartum hemorrhage
200mcg buc >1000ml is similar in the
misoprostol placebo
two groups
Prevention Treatment
Side effect RR 95 % CI
Shivering 4.03 2.8 – 5.7
Pyrexia > 37.8 °C 6.23 3.8 – 9.9
Nausea 5 0.59 – 42.5
Vomiting 2 0.37 – 10.8
Diarrhea 1 0.06 – 15.9