WHO recommendations Uterotonics for the prevention of postpartum haemorrhage: Web annex 3: Misoprostol versus placebo or no treatment
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World Health Organization
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19 p.
This web annex presents the Evidence to Decision (EtD) framework developed to inform WHO recommendations on the use of misoprostol, compared with placebo or no treatment, for the prevention of postpartum haemorrhage among women in the third stage of labour. It summarizes the evidence reviewed for the guideline development process, including the effects of the intervention on priority maternal outcomes, certainty of the evidence, women’s values and preferences, resource requirements, cost–effectiveness, equity, acceptability and feasibility in both hospital and community settings. The document draws primarily on evidence from a network meta-analysis of randomized trials and complementary qualitative and economic reviews. The framework indicates that misoprostol reduces the risk of postpartum haemorrhage, the need for blood transfusion and additional uterotonics, while increasing the risk of some adverse effects, particularly shivering, fever and diarrhoea. It also considers implementation issues, including use in low-resource settings where access to oxytocin or skilled birth attendants may be limited, and reviews evidence on programme feasibility and stakeholder perspectives. The overall assessment of benefits, harms, resources and contextual factors supports the recommendation for the intervention.
This web annex presents the Evidence to Decision (EtD) framework developed to inform WHO recommendations on the use of misoprostol, compared with placebo or no treatment, for the prevention of postpartum haemorrhage among women in the third stage of labour. It summarizes the evidence reviewed for the guideline development process, including the effects of the intervention on priority maternal outcomes, certainty of the evidence, women’s values and preferences, resource requirements, cost–effectiveness, equity, acceptability and feasibility in both hospital and community settings. The document draws primarily on evidence from a network meta-analysis of randomized trials and complementary qualitative and economic reviews. The framework indicates that misoprostol reduces the risk of postpartum haemorrhage, the need for blood transfusion and additional uterotonics, while increasing the risk of some adverse effects, particularly shivering, fever and diarrhoea. It also considers implementation issues, including use in low-resource settings where access to oxytocin or skilled birth attendants may be limited, and reviews evidence on programme feasibility and stakeholder perspectives. The overall assessment of benefits, harms, resources and contextual factors supports the recommendation for the intervention.