Prostaglandins for prevention of postpartum haemorrhage.

BACKGROUND: Prostaglandins have mainly been used for postpartum haemorrhage when other measures fail. Misoprostol, a newer and cheaper prostaglandin E1 analogue, has sometimes been used for management of the third stage of labour. OBJECTIVES: The objective of this review was to assess the effects of prophylactic prostaglandin use in the third stage of labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Researchers in the field were also contacted. Date of the latest search: December 1999. SELECTION CRITERIA: Randomized or quasi-randomized trials comparing a prostaglandin agent with another uterotonic or no prophylactic uterotonic (nothing or placebo) as part of management of the third stage of labour. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality was assessed by one reviewer. MAIN RESULTS: Seven trials were included. There were six trials of injectable prostaglandins and one of rectal misoprostol. The main limitations of these studies are their small sample sizes and lack of blind assessment of the outcomes. Injectable prostaglandins were associated with decreased blood loss (weighted mean difference -72 millilitres, 95% confidence interval -70 to -75) and shortened duration of third stage when compared to other uterotonics. Severe postpartum haemorrhage (1000 millilitres or more blood loss) occurred in two of four studies and was seen in fewer women receiving prostaglandins, though the difference was not statistically significant. Adverse effects (vomiting, diarrhoea and abdominal pain) were more common with prostaglandins when compared to other uterotonic agents. REVIEWER'S CONCLUSIONS: Although injectable prostaglandins appear to be effective in preventing postpartum haemorrhage, concerns about safety and costs limit their suitability for routine prophylactic management of third stage of labour. However, injectable prostaglandins should continue to be used for the treatment of postpartum haemorrhage when other measures fail. Misoprostol is cheap, stable and seems to be safe. Trials addressing the effectiveness of misoprostol are continuing.