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Sir,

We read with interest the report of a randomised placebo-controlled trial involving the administration of misprostol by traditional birth attendants to prevent postpartum haemorrhage in home births in rural Pakistan.1 Although this trial has reiterated the known efficacy of misoprostol in preventing primary postpartum haemorrhage, we feel that it would have been more informative if the trial could have been conducted comparing the efficacy and adverse effect profile of a higher and lower dose of misoprostol, because several studies have shown a similar efficacy with the same dose regimen and placebo in a similar setting.2–4

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