Oral misoprostol for preventing postpartum haemorrhage in home births in rural Bangladesh: how effective is it?

Figures & data

Fig. 1.  Map of study area.

Table 1. Sample profile

	Intervention n=1,009	Control n = 1,008	p-value
Socio-economic
Mean age in years (±SD)	23.0±4.8	22.9±5.0	0.814
Mean years of schooling (±SD)	3.6±3.4	5.0±3.3	<0.001
Educational status
No schooling	36.1	214 (21.2)	0.000
Primary	35.3	321 (31.8)
Secondary or higher	28.6	473 (46.9)
Wealth index (%)
Poorest	14.4	25.6	<0.001
2	21.4	18.7
3	23.6	16.4
4	20.2	19.8
Richest	20.4	19.5
Reproductive
Mean age at first conception (±SD)	16.8 (2.1)	17.5 (2.4)	<0.001
Mean number of pregnancy (±SD)	2.6 (1.4)	2.1 (1.2)	<0.001
Obstetric
Received 4+ ANC from trained providers	87.8	26.4	<0.001
Delivery by skilled birth attendants	9.7	20.7	<0.001
Oxytocin used before/after delivery	13.8	23.5	<0.001
Median risk count for PPH	1 (0–6)	2 (0–8)	<0.001

Table 2. Risk factors for PPH

	OR	CI
ANC (<4)	2.60	1.61–4.19
Antepartum complication	2.89	1.79–4.69
Pre-eclampsia	5.11	1.09–24.05
Complication during delivery	3.23	2.02–5.10
Retained placenta	15.98	9.35–27.29
Prolonged labor	2.69	1.23–5.88
Intrapartum haemorrhage	24.29	7.65–77.13
Manual removal of placenta	12.34	7.28–20.93
Bleeding disorder	3.75	0.45–31.51
Prior PPH	1.85	0.71–4.80

Fig. 2.  Trial profile.

Table 3. Outcome of misoprostol administration according to treatment group

	Intervention n=884 (%)	Control n=1,008 (%)	P-value
Primary outcome
Incidence of PPH	14 (1.6)	65 (6.4)	<0.001
Secondary outcome
Interval between delivery of baby and placenta (>30 min)	31 (3.5)	52 (5.2)	0.035
Manual removal of placenta	26 (2.9)	68 (6.7)	<0.001

Table 4. Additional interventions among PPH cases

	Intervention n=14 (%)	Control n=65 (%)
Need saline and oxytocin injection after delivery at home for treatment of PPH	3 (21.4)	26 (40.0)
Referred to hospital	2 (14.3)	11 (16.9)
Need blood transfusion	0	2 (3.1)
Need other surgical intervention	1 (7.1)	0

Table 5. Adjusted relative risk of blood loss 500 ml or more with misoprostol

	Full model			Final model
Factors	SE	P	RR (95% CI)	SE	P	RR (95% CI)
Misoprostol received
No			1			1
Yes	.588	.001	0.13 (0.04–0.43)	.460	.000	0.19 (0.08–0.48)
Biological factors
Number of conception
< 3			1
≥ 3	.479	.593	1.29 (0.51–3.30)	–
Number of ANC received
4 or more			1
< 4	.498	.396	0.66 (0.25–1.74)	–
Birth attendant at delivery
Trained			1
Untrained	.535	.739	1.19 (0.42–3.41)	–
Retained placenta
No			1
Yes	.833	.792	1.25 (0.24–6.37)	–
Removal of placenta
Spontaneous			1			1
Manual	.750	.042	4.60 (1.05–20.03)	0.486	0.001	5.21 (2.01–13.49)
Antepartum complications
No			1
Yes	.590	.207	2.11 (0.66–6.69)	–
Pre-eclampsia
No			1
Yes	1.287	.614	1.91 (0.15–23.87)	–
Prolong labour
No			1
Yes	.507	.111	2.25 (0.83–6.07)	–
Intrapartum haemorrhage
No			1			1
Yes	.787	.006	8.71 (1.87–40.71)	.702	.000	12.79 (3.23–50.58)
Socio-economic factors
Educational status
No schooling			1
Primary	.539	.290	0.57 (0.20–1.63)	–
Secondary or higher	.535	.751	0.84 (0.30–2.40)	–
Wealth index
Non-poor			1
Poor	.447	.196	0.56 (0.23–1.35)	–

Fig. 3.  Time elapsed between childbirth and misoprostol administration by the community health workers (CHWs).