Review finds insufficient evidence for effectiveness of Cytotec(Pfizer) for preventing PPH

A review finds that there is insufficient evidence for the effectiveness of Cytotec (misoprostol), from Pfizer, a drug increasingly used in low- and middle-income countries for preventing postpartum haemorrhage (PPH). It is given to women during Labour to prevent uncontrolled bleeding, and it is included on the WHO's Essential Medicines List for this use.

However, researchers led by Professor Allyson Pollock from the Centre for Primary Care and Public Health at Queen Mary, University of London, identified 172 studies on the use of misoprostol during labour and found that only six had enough information to enable them to review whether or not the drug was effective in preventing PPH in rural and community settings in low income countries. The six studies failed to provide sufficient evidence that the drug worked and most had problems with study design and the fact the findings were not applicable generally. "Despite there being no proper evidence of benefit, the drug is being pushed hard by networks of global public-private partnerships and industry in low- and middle-income countries. Countries such as Nepal, India and Uganda are promoting and using it. We urge the WHO to urgently review its decision to put misoprostol on its Essential Medicines List," says Prof Pollock.

The review is published in the Journal of the Royal Society of Medicine. See: "Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage." Christina Chu, Petra Brhlikova and Allyson Pollock. Journal of the Royal Society of Medicine 2012: 105: 336-347. doi 10.1258/jrsm.2012.120044