Prevention of postpartum haemorrhage
The full guidance on the prevention of postpartum haemorrhage has been published in the International Journal of Gynecology and Obstetrics 2007;99(supp 2):S198-201, and is available as a read-only pfd file here.
Alternate guidelines for the prevention of postpartum haemorrhage available here.|
Recommended Dosage: 600mcg orally or sublingually stat |
Regimen
A single dose of misoprostol 600 mg orally or sublingually is indicated for prevention of PPH in settings where injectible conventional uterotonics are not available.
Course of Treatment
Misoprostol should be administered by skilled attendants immediately after delivery of the newborn, and after checking that there is no multiple pregnancy. This medication should be followed 1 to 3 minutes later by cord clamping and controlled cord traction as part of the active management of the third stage of labor. Unskilled providers should give misoprostol only after delivery of the placenta because of the risk of inadvertently giving the misoprostol before the delivery of a second twin.
If there is continued hemorrhage, then great care should be taken before repeating misoprostol as cumulative doses may result in side-effects. Causes of hemorrhage other than atony should be sought and the woman should be immediately transferred to a facility where PPH can be treated. In the event of continued hemorrhage, a minimum of 2 hours should lapse after the original dose before a second dose is given. If the initial dose was associated with pyrexia or marked shivering, then at least 6 hours should lapse before the second dose is given.
These recommendations are produced by an expert group on misoprostol brought together by WHO in Bellagio, Italy in Feb 2007. These recommendations do not reflect official WHO guidelines, but have been released early so as to provide guidance to clinicians worldwide. The excerpt above is taken from:
Z Alfirevic, J Blum, G Walraven, A Weeks, B Winikoff. Prevention of Postpartum Hemorrhage with Misoprostol.
International Journal of Gynecology and Obstetrics 2007;99(supp 2):S198-201.
Z Alfirevic, J Blum, G Walraven, A Weeks, B Winikoff. Prevention of Postpartum Hemorrhage with Misoprostol.