Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial


Professor G. Walraven, Secrétariat de Son Altesse l'Aga Khan, Aiglemont, Gouvieux 60270, France.


Objective  To assess the effectiveness of 600 μg oral misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low income country home birth situation.

Design  Double blind randomised controlled trial.

Setting  Twenty-six villages in rural Gambia with 52 traditional birth attendants (TBAs).

Sample  One thousand, two hundred and twenty-nine women delivering at home under the guidance of a trained TBA.

Methods  Active management of the third stage of labour using three 200-μg misoprostol tablets and placebo or four 0.5-mg ergometrine tablets (standard treatment) and placebo. Tablets were taken orally immediately after delivery.

Main outcome measures  Measured blood loss, postpartum haemoglobin (Hb), difference between Hb at the last antenatal care visit and three to five days postpartum.

Results  The misoprostol group experienced lower incidence of measured blood loss ≥500 mL and postpartum Hb <8 g/dL, but the differences were not statistically significant. The reduction in postpartum (compared with pre-delivery) Hb ≥ 2 g/dL was 16.4% with misoprostol and 21.2% with ergometrine [relative risk 0.77; 95% confidence interval (CI) 0.60–0.98; P= 0.02]. Shivering was significantly more common with misoprostol, while vomiting was more common with ergometrine. Only transient side effects were observed.

Conclusions  Six hundred micrograms of oral misoprostol is a promising drug to prevent life-threatening PPH in this setting.