Table 2.

Non-randomized studies on the treatment of PPH with misoprostol

References	Study design/participants	Variable(s) of interest	Results
Prata et al36	Field intervention trial with control group to determine whether traditional birth attendants can diagnose and treat PPH N=849 women enrolled, with N=454 in the intervention arm and N=395 in the nonintervention arm	1,000 µg of misoprostol rectally to all women delivering vaginally with blood loss of 500 mL or more Referral to health facility in control sites	Eight women (2%) in the intervention area and 76 (19%) in the nonintervention area were referred to health facilities after delivery (OR: 0.1; 95% CI: 0.0–0.2) Of those referred, 1% from the intervention area and 95% from nonintervention area needed additional interventions due to PPH
Baruah and Cohn37	Retrospective cohort study with the control arm to assess the efficacy of rectal misoprostol as second-line therapy in the management of primary postpartum hemorrhage compared to methylergonovine N=40 in the study arm and N=18 in the control arm	800–1,000 µg of misoprostol rectally following initial oxytocin therapy compared to 0.2 mg methylergonovine maleate intramuscularly following oxytocin therapy	No significant difference between the two arms in the need for blood transfusion (methylergonovine maleate group, 0%, misoprostol group, 12.5%; P=0.11), the need for third-line medical therapy (methylergonovine maleate group, 55.5%, misoprostol group, 55%; P=0.961) or the need for any surgical intervention (methylergonovine maleate, 22.2%, misoprostol 12.5%; P=0.51)
Okonofua et al38	Cohort study design to investigate the efficacy of misoprostol sublingually to treat PPH in women experiencing PPH from uterine atony in three Nigerian hospitals N=131 women with PPH due to atonic uterus	800 µg of misoprostol immediately after the loss of 500 mL or more blood	15.3% of women required additional treatment with IV oxytocin and ergometrine after the initial administration of sublingual misoprostol 32.8% of women required blood transfusion, while all required IV infusion of saline and plasma expanders No maternal deaths, but five neonatal deaths and two stillbirths Results suggest that misoprostol is safe to be used in all levels of care for the primary treatment of PPH; there is a need for caution in recommending the use of misoprostol as first-line drug for the treatment of PPH in lower levels of care, since many women needed blood/blood products, the possibility of concomitant medical complications that providers need to address with women presenting with PPH, and need for follow-up care after severe PPH episode

Abbreviations: IV, intravenous; PPH, postpartum hemorrhage; CI, confidence interval.