{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:37:49Z","timestamp":1777862269242,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2012,8,1]],"date-time":"2012-08-01T00:00:00Z","timestamp":1343779200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J R Soc Med"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:p>This article describes and critically appraises clinical trials assessing misoprostol effectiveness in preventing primary postpartum haemorrhage (PPH) in home and community settings in low- and middle-income countries. Of 172 identified studies of misoprostol use in labour only six fulfilled the inclusion criteria. All trials used 600\u03bcg misoprostol in the intervention arm; three assessed misoprostol alongside components of active management of the third-stage labour (AMTSL), two used expectant management of labour and one allowed birth attendants to choose management practice. The three AMTSL studies showed no significant differences in PPH incidence or referral to higher centres and only one study showed significant decrease in severe PPH using misoprostol. One expectant management study and the choice of management by birth attendants study found significant decreases in PPH incidence with misoprostol. All studies showed significantly increased risk of shivering with misoprostol. Studies were biased by use of alternative uterotonics in the control arm, confounding management practices, and subjective assessment and, with one exception, exclusion of high-risk women. PPH incidence fell in both the control and intervention groups in both the landmark papers that informed the World Health Organization (WHO) decision to admit misoprostol to the Essential Medicines List. This suggests factors other than misoprostol use are crucial. Current evidence does not support misoprostol use in home and community settings in low- and middle-income countries for PPH prevention. WHO should rethink its recent decision to include misoprostol on the Essential Medicines List.<\/jats:p>","DOI":"10.1258\/jrsm.2012.120044","type":"journal-article","created":{"date-parts":[[2012,8,20]],"date-time":"2012-08-20T10:14:06Z","timestamp":1345457646000},"page":"336-347","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage"],"prefix":"10.1258","volume":"105","author":[{"given":"Christina S","family":"Chu","sequence":"first","affiliation":[{"name":"School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Brhlikova","sequence":"additional","affiliation":[{"name":"School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allyson M","family":"Pollock","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health, Queen Mary University of London, London E1 2AD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2012,8,20]]},"reference":[{"key":"bibr-JRSM-12-0044C1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60518-1"},{"key":"bibr-JRSM-12-0044C2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61572-4"},{"key":"bibr-JRSM-12-0044C3","unstructured":"WHO. The World Health Report 2005. Make every mother and child count 2005. See http:\/\/www.who.int\/whr\/2005\/whr2005_en.pdf (last accessed 3 July 2012)"},{"key":"bibr-JRSM-12-0044C4","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/131.2.604S"},{"key":"bibr-JRSM-12-0044C5","volume-title":"Worldwide Prevalence of Anaemia 1993\u20132005: WHO Global Database on Anaemia","author":"WHO","year":"2008"},{"key":"bibr-JRSM-12-0044C6","volume-title":"WHO Recommendations for the Prevention of Postpartum Haemorrhage","author":"WHO","year":"2007"},{"key":"bibr-JRSM-12-0044C7","volume-title":"Stability of Injectable Oxytocics in Tropical Climates: Results of Field Surveys and Simulation Studies on Ergometrine, Methylergometrine and Oxytocin \u2013 EDM Research Series No. 008","author":"Hogerzeil H","year":"1993"},{"key":"bibr-JRSM-12-0044C8","unstructured":"WHO. WHO statement regarding the use of misoprostol for postpartum haemorrhage prevention and treatment. 2009. See http:\/\/www.who.int\/reproductivehealth\/publications\/maternal_perinatal_health\/misoprostol\/en\/ (last accessed 3 July 2012)"},{"key":"bibr-JRSM-12-0044C9","volume-title":"Prevention and Treatment of Post-partum Haemorrhage. New Advances for Low Resource Settings. 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