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Treatment for primary postpartum haemorrhage.

BACKGROUND
Primary postpartum haemorrhage is one of the top five causes of maternal mortality in both developed and developing countries.


OBJECTIVES
The objective of this review was to assess the effectiveness and safety of pharmacological and surgical interventions used for the treatment of primary postpartum haemorrhage.


SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's trials register (April 2002).


SELECTION CRITERIA
Randomised or quasi-randomised controlled trials comparing pharmacological, surgical and radiological interventions for the treatment of primary postpartum haemorrhage.


DATA COLLECTION AND ANALYSIS
Studies were assessed for eligibility and quality by reviewers independently. Data were extracted into pre-specified data sheets. Authors of the included study were contacted for more information. Analysis was by intention to treat. Results are presented as relative risk with 95% confidence intervals using the fixed effects model.


MAIN RESULTS
One trial, comparing rectally administered misoprostol versus syntometrine combined with an oxytocin infusion, met the eligibility criteria and was included in the review. It was not large enough to evaluate the effects of rectal misoprostol on maternal mortality, serious maternal morbidity or hysterectomy rates in women with primary postpartum haemorrhage. Compared with a combination of intramuscular syntometrine injection and oxytocin infusion, rectal misoprostol administration showed a statistically significant reduction in the number of women who continued to bleed after the intervention and those who required medical co-interventions to control the bleeding (6% versus 34%) (relative risk 0.18, 95% confidence interval 0.04 to 0.67). However, there was no significant difference between the two groups regarding surgical interventions to control intractable haemorrhage including hysterectomy, internal iliac artery ligation and/or uterine packing.


REVIEWER'S CONCLUSIONS
Rectal misoprostol in a dose of 800 micrograms could be a useful 'first line' drug for the treatment of primary postpartum haemorrhage. Further randomised controlled trials are required to identify the best drug combinations, route, and dose for the treatment of postpartum haemorrhage.