Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: results of a multicenter trial.

Aim The study investigated the effectiveness of sublingual misoprostol when used as primary treatment of primary post-partum hemorrhage (PPH) in a low-income country. Methods Maternity care providers in three Nigerian hospitals administrated 800 μm sublingual misoprostol to women experiencing PPH. The outcome variables were estimated blood loss and the need for additional uterotonic drugs after initial treatment with misoprostol. Entry criteria included women in term spontaneous labor, while exclusion criteria were women with operative delivery and those experiencing PPH not due to atonic uterus. Results One hundred and thirty-one women with PPH were treated over 6 months. Estimated blood loss ranged 500–2500 mL. Twenty women (15.3%) required additional uterotonic drugs to control continuing blood loss. There were no maternal deaths, while seven perinatal deaths were recorded. Conclusion We conclude that although sublingual misoprostol is effective in reducing blood loss due to PPH, it does not effectively treat all forms of PPH. Additional uterotonics and other ancillary treatments would be required.