Oral misoprostol, a drug used to prevent stomach ulcers, has been shown to substantially reduce haemorrhage in women who have just given birth in rural, developing communities. The researchers report their findings in this week's issue of The Lancet.

Every year half a million women die worldwide from pregnancy-related causes. Haemorrhage after delivery is the most common cause of maternal mortality, responsible for one in three of these deaths. 99% of these deaths occur in the developing world where women frequently deliver in rural settings in the absence of any medical staff or preventive medication.

The placebo-controlled trial monitored maternal blood loss during the two hours after delivery as well as eventual outcomes (including transfer to hospital and surgical intervention) for 1620 women in rural India. Study participants were randomised to either misoprostol tablets (600g single dose) or placebo.

The results showed that misoprostol reduced the incidence of haemorrhage by almost half (12.0% to 6.4%) compared with placebo. A reduction in the number of severe haemorrhage cases was also observed (1.2% to 0.2%). Mean postpartum blood loss was noted to be significantly lower in the misoprostol group (262.3mL to 214.3mL).

The paper highlights how injectable oxytocin remains the gold standard treatment for preventing haemorrhage after delivery, although it is not a feasible option in rural, resource-poor areas where women give birth outside of a hospital environment.

Author Stacie Geller (University of Illinois, Chicago, USA) states: "Our results show that oral misoprostol is safe, effective and inexpensive for women giving birth in low-resource settings, and is currently the only available pharmacological option for preventing postpartum haemorrhage and reducing postpartum blood loss in these communities."