Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

Table 6 Adverse outcomes

Outcomes	N of occurrences in programs reporting¹(total # of women taking misoprostol at home births²)	Frequency (range)
Administration before birth	7³ (12,615)	0.06% (0%–0.23%)
Maternal deaths
Total	51 (86,732)	0.06% (0%–1.72%)
Deaths due to PPH/excessive bleeding	24 (86,732)	0.03% (0.00%–0.16%)
Perceived PPH/excessive bleeding	194 (72,534)	0.3% (0%–8.9%)
Other adverse outcomes requiring hospital referral⁴	27 (86,732)	0.03% (0%–0.3%)

¹ For Administration Before Birth and Perceived PPH/Excessive Bleeding, only those programs reporting comparable data for the specific category have been included in the calculation. For Maternal Deaths and other adverse outcomes requiring hospital referral, because of the severity of these outcomes, it has been assumed that if a study or program reported data on at least one of these outcomes and did not mention other outcomes, the other outcomes did not occur.
² Some programs only collected data on these outcomes for a subsample of women taking misoprostol for home births, as noted in Table 2. The Administration Before Birth total includes subsample numbers if both overall and subsample numbers are available. The Adverse Maternal Outcomes data, however, includes overall numbers wherever available because the presence of community information sources makes it likely that such outcomes would be known and noted for the entire home-birth misoprostol population.
³ This includes one inferred occurrence from information that one woman in the Ghana program took misoprostol at the incorrect time and not after delivery of the placenta.
⁴ Such outcomes were enumerated in 2 programs. In one program, the outcomes were reported as including “retained placenta, postpartum eclampsia, severe lower abdominal pain, and lack of typical postpartum bleeding.” In the other program, the outcome enumerated was “severe postpartum anaemia.”

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