I) 'Treatment of Post-partum Haemorrhage with sublingual Misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial.'

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This study investigated if 800mcg of sublingual Misoprostol or 40 IU IV oxytocin was more effective at treating PPH in women undergoing physiological third stage management. The primary outcomes measured were if active bleeding was controlled within 20 minutes and if 'additional blood loss' of 300mL or more occured. Active bleeding was controlled within 20 minutes for 90% of the Misoprostol group and 96% of the oxytocin group. In women who recieved oxytocin, the median time to control active bleeding was 2 minutes faster than for Misoprostol. Additional bleeding occured more frequently in the Misoprostol group and more women needed additional uterotonics and other interventions (such as blood transfusions). Misoprostol was also associated with a higher incidence of shivering and pyrexia, but it was noted that these were transient and did not cause complications. The authors' estimated efficacy for oxytocin was that it would control active bleeding within 20 minutes for 88% of women and both misoprostol and oxytocin were more effective than this. It thus concluded that although oxytocin should be the first choice of treatment - due to being more effective and producing less side-effects - misoprostol is also an effective alternative.

II) 'Treatment of Post-partum Haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double-blind, randomised, non-inferiority trial.'

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This study investigated if 800mcg of sublingual misoprostol or 40 IU IV oxytocin was more effective at treating PPH, in women who had alreday received oxytocin prophylaxis in the third stage of labour. The same primary outcomes measured were if active bleeding was controlled within 20 minutes and if 'additional blood loss' of 300mL or more occurred. Active bleeding was controlled within 20 minutes for 89% of the misoprostol group and 90% of the oxytocin group. The number of women with additional bleeding however were similar in the two groups. Side effects of shivering and pyrexia were more common in the misoprostol group. Compared with when women had not recieved oxytocin prophylaxis in the previous trial, both misoprostol and oxytocin were less successful at PPH treatment; the average time taken for active bleeding to cease was 7 minutes more. In conclusion, for those women already given oxytocin prophylaxis, misoprostol and oxytocin are of very similar efficacy. 

III) 'Misoprostol as an adjunct to standard uterotonics for treatment of post-partum haemorrhage: a multicentre, double-blind randomised control trial.' 

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This study investigated 600mcg Misoprostol administered to women diagnosed with PPH as well as the administration of an injectable uterotonic. The aim of the trial was to see if Misoprostol as an adjunct treatment could prevent further blood loss - the primary outcome was whether blood loss of 500mL or more occurred within 60 minutes. No difference was observed between the groups for the primary outcome. Thus, this trial concluded that there was no evidence that the use of Misoprostol as an adjunctive therapy to oxytocin is of any benefit in PPH treatment. Not only was there no evidence of it's beneficial nature, side effects of shivering and pyrexia were higher in the misoprostol group.