Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
In settings where women give birth outside of a health facility and in the absence of skilled health personnel, a strategy of antenatal distribution of misoprostol to pregnant women for self-administration is recommended for prevention of postpartum haemorrhage, only with targeted monitoring and evaluation
Context specific recommendation
Only in specific contexts
Notes and Remarks
- Antenatal distribution of misoprostol to pregnant women should not replace standard policies for scaling up effective uterotonic use, but it should be considered as a strategy for increasing coverage of uterotonic use in settings where a large proportion of women still give birth outside health facilities and where it is highly likely that skilled health personnel will not be present at the time of birth.
- While acknowledging that there is currently no clear evidence of harm with a strategy of antenatal misoprostol distribution, the GDG agreed that to address potential safety concerns, such programmes should only be implemented with appropriate monitoring and evaluation. These should consider:
- whether women are trained appropriately in the use of misoprostol;
- monitoring the distribution, use and potential misuse of misoprostol;
- the effect of the programme on the use of health services and health outcomes – this should include (but is not limited to) the rate of ANC attendance and facility-based childbirth, maternal and perinatal mortality, and severe maternal morbidity and potential complications from inappropriate use (such as uterine rupture); and
- whether appropriate supervisory systems of health personnel involved in the distribution of misoprostol are in place. Within an antenatal distribution programme, misoprostol ideally should be provided to women during an ANC visit in the third trimester of pregnancy (typically as part of a safe delivery kit). It should be accompanied by clear, culturally appropriate instructions on its purpose, correct dose (400 or 600 μg for oral administration) and timing of use, possible side-effects and remedies for these, prompt recognition of danger signs and how to access health services, while emphasizing the importance of giving birth in a health facility.
- In settings where a strategy of antenatal distribution of misoprostol will be initiated, prospective research that evaluates the impact of introducing these programmes on maternal health outcomes and health service use should be considered a priority.