With the emerging evidence on the use of various routes of administration of misoprostol, particularly in the non-hospital setting, it is becoming clear that this drug should be available at the community level in the hands of trained personnel, especially where oxytocin, Uniject and other uterotonics are not present or practical for use.’ The Working Group of the Goa International Conference on the Prevention of Post Partum Hemorrhage, July 15, 2006, Goa, India | Section IV Special preventive measures misoprostol in action With the emerging evidence on the use of various routes of administration of misoprostol particularly in the non-hospital setting it is becoming clear that this drug should be available at the community level in the hands of trained personnel especially where oxytocin Uniject and other uterotonics are not present or practical for use. The Working Group of the Goa International Conference on the Prevention of Post Partum Hemorrhage July 15 2006 Goa India 16 MISOPROSTOL IN PRACTICE M. Potts Prior to the availability of misoprostol it was impossible to carry any significant element of emergency obstetric care into homes where women deliver without a skilled birth attendant. As a low-cost easy-to-administer powerful uterotonic with an excellent safety profile and long shelf-life misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage in precisely those situations where it is most common - delivery at home without a skilled birth attendant. In a placebo-controlled community-based trial in India administration of 600 misoprostol orally immediately after delivery significantly reduced postpartum hemorrhage see Addendum . Research in Indonesia Nepal and elsewhere is showing that community volunteers with minimal training can teach illiterate women to self-administer misoprostol effectively and responsibly1 see Chapter 19 . A 1000 rectal dose of misoprostol can be used to treat postpartum hemorrhage in situations where an appropriate technology exists to diagnose blood loss such as blood-soaked sarong or kanga and where births are attended by traditional birth attendants TBAs . In Tanzania illiterate TBAs with a brief training used misoprostol to bring about a highly significant reduction in the number of women who needed to be referred to hospital or receive intravenous treatment2. Although these measures may seem revolutionary at first glance they should be .
