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• W2046895437 abstract "The study by Christina Pagel and colleagues1Pagel C Lewycka S Colbourn T et al.Estimation of potential effects of improved community-based drug provision, to augment health-facility strengthening, on maternal mortality due to post-partum haemorrhage and sepsis in sub-Saharan Africa: an equity-effectiveness model.Lancet. 2009; 374: 1441-1448Summary Full Text Full Text PDF PubMed Scopus (48) Google Scholar on the community-based provision of drugs to reduce maternal mortality adds to a growing and compelling body of evidence2Prata N Gessessew A Abraha AK Holston M Potts M Prevention of postpartum hemorrhage: options for home births in rural Ethiopia.Afr J Reprod Health. 2009; 13: 87-95PubMed Google Scholar that, in regions where home births are prevalent, empowering women to use misoprostol to control post-partum haemorrhage at home is a viable and effective way to reduce maternal mortality. The International Federation of Gynaecology and Obstetrics (FIGO), the International Confederation of Midwives (ICM),3International Confederation of Midwives (ICM) / International Federation of Gynaecology and Obstetrics (FIGO)Prevention and treatment of post-partum haemorrhage: new advances for low resource settings: joint statement.http://www.pphprevention.org/files/FIGO-ICM_Statement_November2006_Final.pdfGoogle Scholar and, in a 2007 report, WHO4WHOWHO recommendations for the prevention of postpartum haemorrhage.http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdfGoogle Scholar have endorsed use of misoprostol at the community level. However, WHO has now reversed its earlier position. Its most recent statement declares: “WHO does not recommend distribution of misoprostol to community-level health workers or women and their families for routine or emergency use.”5WHOWHO Statement regarding the use of misoprostol for postpartum haemorrhage prevention and treatment.http://whqlibdoc.who.int/hq/2009/WHO_RHR_09.22_eng.pdfGoogle Scholar We find the reasons given (minor inconsistencies in clinical trials, increased risk of shivering or fever, and “an unresolved concern of a possible increase in the risk of maternal mortality”) contrived and unsubstantiated. These risks pale in comparison to the very real danger of post-partum haemorrhage after home births where skilled attention is inaccessible. Pagel and colleagues estimate that tens of thousands of maternal deaths could be averted in sub-Saharan Africa alone by widespread community use of misoprostol. The women at greatest risk from the scourge of post-partum haemorrhage have no direct voice, but we, the undersigned, call on senior members of WHO to (a) re-evaluate the place of misoprostol in the Essential Medicines List, and (b) reissue their recommendation on the use of misoprostol during home births, bringing it in line with the current evidence base. We declare that we have no conflicts of interest." @default.
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• W2046895437 date "2010-02-01" @default.
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• W2046895437 title "Empowering women to control post-partum haemorrhage" @default.
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• W2046895437 doi "https://doi.org/10.1016/s0140-6736(10)60192-4" @default.
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