Post-partum Hemorrhage
Misoprostol is also used to prevent and treat post-partum hemorrhage. Orally administered misoprostol at a dosage of 600 ug was tested versus oxytocin 10iu in a large randomised controlled study. The study which involved a substantial number of patients receiving either oral or intravenous oxytocin showed that misoprostol is marginally less effective for this purpose. The use of rectally administered misoprostol is optimal in cases of haemorrhage; it was shown to be associated with lower incidence of side effects compared to other routes for this particular indication. Rectally administered misoprostol at dosages of 800ug or 1000 ug was reported in a variety of case reports and randomised controlled trials. However, it is inexpensive and thermostable (thus does not require refrigeration like oxytocin) making it a cost effective and valuable drug to use in the developing world. A randomised control trial of misoprostol use found a 38% reduction in maternal deaths due to post-partum haemorrhage in resource-poor communities. Misoprostol is recommended due to its cost, effectiveness, stability, and low rate of side effects. Oxytocin must also be given by injection, while misprostol can be given orally or rectally for this use, making it much more useful in areas where nurses and physicians are less available.
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