A big question mark has been placed over the efficacy of misoprostol as a treatment for excessive bleeding in women who have given birth, despite it having been backed by the World Health Organisation for this use.

Researchers analysed a total of 172 studies on the use of misoprostol to prevent postpartum haemorrhage (PPH), but found that just a mere six of them provided enough quality data on its efficacy in rural and community settings in low income countries.

Moreover, these six trials failed to throw up sufficient proof of efficacy, with the evidence underpinning the use of misoprostol in this setting "at best weak and inconclusive", the study authors said.

All of the studies "show limitations with regard to study design, exclusion criteria, intervention and controls, and use of outcomes", the analysis, published in the Journal of the Royal Society of Medicine, concluded.

Consequently, researchers have called on WHO to reconsider the drug's standing on its essential medicines list, which highlights the drugs crucial for taking care of the priority healthcare needs of the population, particularly as it is becoming more popular in developing countries.

"Developed countries would not dream of giving women misoprostol during labor on the basis of the current evidence, yet industry and health practitioners are pushing it hard in developing countries," argued study lead Allyson Pollock of London's Queen Mary University.

Popularity explained

Misoprostol is a fairly stable drug, it doesn’t degrade in warm conditions, and it does not have to be given intravenously, which explains its popularity in developing countries and why it is more likely to be used outside hospitals.

But "the most effective preventive strategy for PPH is prevention of anaemia, good antenatal care including good hygiene and sanitation and good care during labour,” Professor Pollock stressed. 

According to WHO's 2008 estimate, more than 340,000 women lost their lives because of issues related to pregnancy and childbirth - with the majority in developing countries - and a quarter of these are though to be linked with PPH following a vaginal delivery.