Treatment for primary postpartum haemorrhage

Cochrane Review by Mousa HA, Alfirevic Z

This record should be cited as: Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003249. DOI: 10.1002/14651858.CD003249.pub2.

ABSTRACT

Title

Treatment for primary postpartum haemorrhage

Background

Primary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries.

Objectives

To assess the effectiveness and safety of pharmacological, surgical and radiological interventions used for the treatment of primary PPH.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2006).

Selection criteria

Randomised controlled trials comparing pharmacological, surgical techniques and radiological interventions for the treatment of PPH.

Data collection and analysis

We assessed studies for eligibility and quality, and extracted data, independently. We contacted authors of the included studies for more information.

Main results

Three studies (462 participants) were included. Two placebo-controlled randomised trials compared misoprostol (dose 600 to 1000 mcg) with placebo and showed that misoprostol use was not associated with any significant reduction of maternal mortality (two trials, 398 women; relative risk (RR) 7.24, 95% confidence interval (CI) 0.38 to 138.6), hysterectomy (two trials, 398 women; RR 1.24, 95% CI 0.04 to 40.78), the additional use of uterotonics (two trials, 398 women; RR 0.98, 95% CI 0.78 to 1.24), blood transfusion (two trials, 394 women; RR 1.33, 95% CI 0.81 to 2.18), or evacuation of retained products (one trial, 238 women; RR 5.17, 95% CI 0.25 to 107). Misoprostol use was associated with a significant increase of maternal pyrexia (two trials, 392 women; RR 6.40, 95% CI 1.71 to 23.96) and shivering (two trials, 394 women; RR 2.31, 95% CI 1.68 to 3.18).

Authors' conclusions

There is insufficient evidence to show that the addition of misoprostol is superior to the combination of oxytocin and ergometrine alone for the treatment of primary PPH. Large multi-centre, double-blind, randomised controlled trials are required to identify the best drug combinations, route, and dose of uterotonics for the treatment of primary PPH. Further work is required to assess the best way of managing women who fail to respond to uterotonics therapy.

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