Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Misoprostol (either 400 μg or 600 μg, orally) is recommended for the prevention of postpartum haemorrhage for all births
Recommended
Notes and Remarks
- The GDG noted that evidence on the efficacy of misoprostol was largely derived from trials involving women giving birth vaginally. However, misoprostol has been used for women giving birth via caesarean section in a few trials. The GDG emphasized that there may be a need for the use of alternative routes of administration, such as rectal for women under general anaesthesia for caesarean section, or rectal or sublingual for women under spinal anaesthesia for caesarean section.
- The GDG advised that all women are to be provided with information – ideally during antenatal care – on the need for an effective uterotonic to prevent PPH.
- The GDG noted that previous trials have largely used 600-μg or 400-μg doses of misoprostol. While there is currently no clear evidence to demonstrate that a 600-μg dose provides greater efficacy over a 400-μg dose, there is some evidence that higher doses are likely to have worse side-effects.
- To maximize efficacy, misoprostol is best given immediately (preferably within 1 minute) after the birth of the baby or babies. Administration for the prevention of PPH need not impede the delaying of cord clamping.
- Although different routes of administration (i.e. oral, buccal, sublingual, rectal) have been evaluated in trials of misoprostol for PPH prevention, the recommended route of administration is based on the consideration of a woman’s preferences for oral over rectal administration
- Providers administering misoprostol need to ensure that women are aware of the possible adverse effects of misoprostol (including shivering, fever and diarrhoea), and must be prepared to manage these if they occur.
- Misoprostol for PPH prevention can be used in both hospital and community settings