Uganda Moves Closer to Using Misoprostol to Curb Postpartum Hemorrhage

In low- and middle-income countries women continue to die each day during and immediately after childbirth mainly due to postpartum hemorrhaging (PPH). In fact, most maternal deaths in sub-Saharan Africa (440 every day) are caused by PPH.

The World Health Organization’s strong recommendation to save mothers who experience PPH is to administer oxytocin, the most effective drug to stop hemorrhaging. The problem, however, is oxytocin must be kept refrigerated. Most health centers and hospitals in low resource areas lack electricity or have spotty service making the use of oxytocin improbable to impossible. Oxytocin must also be injected by a skilled health worker which causes another barrier to its universal use. For African women, who likely live great distances from their closest health center, the chances of delivering their baby with a skilled health professional are increasingly low.

Scientists in Uganda recently conducted a double-blind, randomized trial where they compared the use of oxytocin and misoprostol, an oral drug that also stops postpartum hemorrhaging. They found that misoprostol can effectively be used against PPH because it can be taken as a pill and does not need to be refrigerated. In cases where oxytocin and health workers are not available the World Health Organization has also recommended the use of misoprostol. This recommendation has stood since 2011.

Although misoprostol has been used and distributed to health centers in Uganda since 2010 the researchers acknowledge that the drug has been illegally abused because it can also be used for abortions. Researchers also admit that oxytocin is a superior drug to reduce PPH because misoprostol often causes shivering and fevers in addition to stopping hemorrhages.

While misoprostol seems to be the likely alternative to oxytocin in resource-poor settings, researchers in Australia at Monash University as well as their global partners Glaxo Smith Kline, McCall MacBain Foundation, Grand Challenges Canada and Planet Wheeler Foundation are currently collaborating on an inhaled oxytocin product that does not require refrigeration while still saving mothers’ lives.