Background Evidence

Post-partum haemorrhage (PPH) is the most important direct cause of maternal mortality in low resource countries, and one of the most preventable. As the most com-mon cause for PPH is the failure of the uterus to contract adequately (atonic uterus), a key aspect in prevention of PPH is uterotonic therapy. The most wide-ly used agent is injectable oxytocin. How-ever, it requires parenteral administration, and, therefore, skills to give injections as well as sterile equipment; and refrigeration. For this reason, misoprostol, an E1 prostaglandin analogue, has attracted considerable attention as an alternative to oxytocin for the prevention of PPH in re-source poor settings. Misoprostol is ef-fective, simple to administer, and presents none of the logistical difficulties associat-ed with use of oxytocin