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The abortion drug misoprostol can be used to help save the lives of women who bleed heavily after giving birth, say researchers. The condition is a major killer of women in developing countries.

The results of a clinical trial in rural India published today (6 October) in The Lancet indicate that misoprostol reduced the incidence of postpartum haemorrhage by almost half.

Death due to postpartum haemorrhage accounts for almost 30 per cent of maternal deaths in India, where nearly half of all births take place in the home or in facilities without a trained gynaecologist or obstetrician in attendance.

"The researchers showed that giving women misoprostol after birth is a safe, inexpensive means of preventing postpartum haemorrhage from occurring," says Elias Zerhouni, director of the US National Institutes of Health, which was involved in the study. "This advance has the potential to save thousands of lives each year."

The trial involved 1620 female volunteers, half of whom received a placebo. The other half received 600 micrograms of misoprostol, taken by mouth. Average blood loss was found to be significantly lower in the misoprostol group.  

The team led by Stacie Geller — director of the National Center of Excellence in Women’s Health at the University of Illinois, United States — says the results show that misoprostol is safe, effective and inexpensive for women giving birth in resource-poor settings.

The researchers say it is "currently the only available pharmacological option for preventing postpartum haemorrhage and reducing postpartum blood loss in these communities".

Last week, US-based researchers writing in the British Medical Journal said that if misoprostol had been implemented earlier, instead of waiting for it to go through clinical trials in resource-poor settings, many women's lives could have been saved (see Wait for clinical trial data causes 'avoidable deaths').

A major concern is the potential for the misuse of misprostol in India, says Kamala Ganesh, former professor of gynaecology at the Maulana Azad Medical College, Delhi.

The drug is available, although illegally, as an over-the-counter pill. Approved for use in India in 2002, it is only supposed to be taken under medical supervision, yet it is sold in several pharmacies.

Ganesh says misprostol could be used by families to coerce women into selectively aborting female fetuses.

Misoprostol has in any case had a chequered history in India. Women’s groups and activists protested against introducing it as an abortion pill, citing side-effects including severe cramps and vaginal bleeding.

Link to full paper in The Lancet*
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Reference: The Lancet  368, 9543 (2006)

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