Master's Culminating Experience
Objective: The purpose of this systematic review is to determine the role misoprostol currently plays in the reduction of maternal deaths and implications for the future reduction of maternal deaths in low resource settings.
Methods: A comprehensive review of the literature was performed using the following databases: The Cochrane Database, Ebsco, MEDLINE, PubMed, and Electronic Journal Center (EJC). Articles were excluded based upon date published, overt data changes since publication, and setting of misoprostol interventions in tertiary or referral centers that have access to oxytocin. A total of 61 articles were included from 2002-2012 and demonstrated several methodologies and study designs. Review of several program field guides and position statements by key stakeholders were incorporated into this comprehensive literature review.
Discussion: Postpartum hemorrhage accounts for nearly 25% of maternal deaths globally and is most likely to involve the poorest; most underserved, and marginalized women. South Asia and Sub-Saharan Africa comprise the greatest numbers of these women. Widespread use of misoprostol in the treatment and prevention of postpartum hemorrhage remains controversial. The lack of clarity and vigor by the WHO guidelines regarding the use of misoprostol for prevention of PPH at the community level has further impeded efforts aimed at the reduction of maternal deaths due to postpartum hemorrhage. Task shifting strategies will play a crucial role to the successful implementation of community distribution programs that have been proven to save the lives of mothers in low resource areas where maternal deaths are the most profoundly experienced.
McMillian, M. A. (2012). The Role of Misoprostol in the Reduction of Maternal Deaths in Low Resource Settings: A Systematic Review with Recommendations for Action. Wright State University, Dayton, Ohio.