Life Blood: Drug stops mothers’ bleeding after births

A drug sometimes used to induce abortions can stem bleeding after childbirth, according to a 3-year study in India. It might save the lives of millions of women in developing countries, the researchers say.

Worldwide, the leading cause of a mother’s death during childbirth is postpartum hemorrhage. When the uterus fails to contract after a baby is delivered, the site where the placenta detached can bleed excessively.

In countries where babies are routinely delivered in hospitals, women who have just given birth typically receive an injection of one of several synthetic forms of the hormone oxytocin, which make the uterus contract. However, these drugs aren’t often available to women in developing countries, explains epidemiologist Stacie Geller of the University of Illinois in Chicago.

“In rural areas, many women deliver in very primitive conditions,” notes Geller. Their birth attendants typically aren’t trained to administer injections. Even if they are, adds Geller, synthetic oxytocin needs to be refrigerated to remain stable, a luxury not available in many parts of the world.

The drug in the new study is misoprostol. Because it causes uterine contractions, it’s sometimes prescribed to induce or aid abortions. Some doctors have suggested giving misoprostol, which is manufactured as a tablet, to women who don’t have access to synthetic oxytocin. However, previous studies of a few hundred patients each didn’t prove that misoprostol controls postpartum hemorrhage.

To investigate misoprostol’s effectiveness in a larger population, Geller and her colleagues headed to rural India. There, women typically deliver their babies at home or in primitive facilities with no trained medical personnel. The researchers studied 1,620 women who gave birth between 2002 and 2005. About half of the women received a dose of misoprostol after their deliveries, and the other women received an identical-looking placebo.

Twelve percent of patients in the placebo group, compared with only 6 percent in the group taking misoprostol, had serious post-partum hemorrhage, the researchers report in the Oct. 7 Lancet.

“It’s a pretty phenomenal result,” says Geller.

Yap-Seng Chong, a researcher at the National University of Singapore who has also studied misoprostol’s use in labor and delivery, agrees. “This could be the answer” for preventing many cases of postpartum hemorrhage in rural areas, he says.

Chong points out that while this study’s results are promising, misoprostol sometimes causes troubling side effects, such as severe shivering and fever. However, he notes that the benefits of the drug far outweigh the risks. “I’d rather [that a woman have a] fever and shiver than bleed to death,” he says.

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