This article in the Drug and Therapeutics Bulletin (DTB) considers the use of misoprostol as prevention of and treatment for postpartum haemorrhage, an unlicensed indication. The following topics are covered:

• About postpartum haemorrhage
• Traditional preventive and treatment options
• About misoprostol
• Efficacy: Prevention of postpartum haemorrhage (Misoprostol vs. placebo, Misoprostol vs. uterotonics, misoprostol plus oxytocin vs. injectable uterotonics)
• Treatment for postpartum haemorrhage (misoprostol vs. placebo, misoprostol vs. oxytocin)
• Cautions and unwanted effects
• What guidelines say
• What dose?
• Costs
• Implications for practice

The article concludes that “misoprostol should not replace oxytocin as prophylaxis or treatment for postpartum haemorrhage. However, at a dose of 600μg orally or sublingually, it may be useful for prevention in settings where oxytocin is unavailable (e.g. rural low-resource areas). With such use, early controlled cord traction should not be done, to reduce the likelihood of placental detachment (and resulting bleeding) before an effective serum misoprostol concentration has been reached.”