Aim To assess the effectiveness and safety of interventions used for the treatment of primary postpartum haemorrhage (PPH).
Methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register for randomised and quasi-randomised controlled trials for the treatment of primary PPH.
Results Twelve randomised clinical trials (RCT) with a total of 4060 participants fulfilled our inclusion criteria and were included in this review. Four RCTs (1483 participants) compared misoprostol with placebo given in addition to conventional uterotonics. Adjunct use of misoprostol to additional uterotonics had no impact on our primary outcomes including maternal mortality (risk ratio (RR) 6.16; 95% confidence interval (CI) 0.75 to 50.85), serious maternal morbidity (RR 0.34; 95% CI 0.01 to 8.31); admission to intensive care (RR 0.79; 95% CI 0.30 to 2.11), or hysterectomy (RR 0.93; 95% CI 0.16 to 5.41).
Two RCTs (1851 participants) compared 800 mcg sublingual misoprostol to oxytocin infusion as primary PPH treatment. Primary outcomes did not differ between the two groups. Five trials examined the effectiveness of oestrogen, tranexamic acid, lower segment compression and aortic compression devices, but were too small to assess impact on primary outcomes.
Conclusion Compared with misoprostol, oxytocin infusion is more effective and causes fewer side effects when used as the first-line therapy for the treatment of primary PPH. There is no evidence to suggest that misoprostol is effective as an adjunct to uterotonic treatment for primary PPH. Misoprostol should be considered as first-line uterotonic in settings where injectable oxytocics are not available.
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