Just flagging that (in NZ at least), misoprostol is not given routinely for prevention of PPH. That’s probably because there’s access to IV oxytocin, so if you already have that in your practice then it’s probably worse for patient outcomes to change to misoprostol.[1] If there’s no access to IV oxytocin though, then misoprostol is recommended as second line recommendation by other bodies (FIGO 2022).
Alongside access to ecbolics, fairly simple things like active management of third stage of labour is probably pretty important in reducing PPH (my guess is the NNT of active management is probably comparable or lower than administering misoprostol for PPH prevention, though I’m less sure about the cost-effectiveness of scalable interventions in these areas).
Thanks so much for this Bruce—I had completely missed the fact that oxytocin was still clearly better—our faciities which deliver babies (apart from one) have fridges and already use that, although we don’t have standard practice of using it for every delivery which we should! (We use for most). I know that’s a bad miss by me.
So it seems like if you have a fridge—Oxytocin (it’s cheap anyway), and if not misoprostol.
Thanks so much again. In my defence I would have talked to the midwives and would have read guidelines before making that mistake anyway.
Just flagging that (in NZ at least), misoprostol is not given routinely for prevention of PPH. That’s probably because there’s access to IV oxytocin, so if you already have that in your practice then it’s probably worse for patient outcomes to change to misoprostol.[1] If there’s no access to IV oxytocin though, then misoprostol is recommended as second line recommendation by other bodies (FIGO 2022).
Alongside access to ecbolics, fairly simple things like active management of third stage of labour is probably pretty important in reducing PPH (my guess is the NNT of active management is probably comparable or lower than administering misoprostol for PPH prevention, though I’m less sure about the cost-effectiveness of scalable interventions in these areas).
Note this also seems to be true for management of PPH.
Thanks so much for this Bruce—I had completely missed the fact that oxytocin was still clearly better—our faciities which deliver babies (apart from one) have fridges and already use that, although we don’t have standard practice of using it for every delivery which we should! (We use for most). I know that’s a bad miss by me.
So it seems like if you have a fridge—Oxytocin (it’s cheap anyway), and if not misoprostol.
Thanks so much again. In my defence I would have talked to the midwives and would have read guidelines before making that mistake anyway.