JSI Research & Training Institute, Inc./ The Last Ten Kilometers (L10K) Project, Addis Ababa, Ethiopia.
Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.
BMC Pregnancy Childbirth. 2019 Nov 6;19(1):404. doi: 10.1186/s12884-019-2539-5.
Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse.
We included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated.
Three qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups [OR 1.011; 95% CI: 0.906-1.129]. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases. In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed.
The claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages, especially in resource-limited settings.
在分娩前向孕妇分发米索前列醇是预防产后出血的一种强制性策略。据报道，这种分发方式可能会导致分娩地点转移到医疗机构之外，或者导致药物的不当使用。本范围界定审查旨在综合社区分发米索前列醇对医疗机构分娩率的影响的证据，并评估在分娩前服用分发的米索前列醇的母亲的频率，以及这种滥用的任何有害后果。
我们纳入了来自 PubMed、Cochrane 评论库、Popline 和 Google Scholar 的关于米索前列醇实施的同行评审文章。使用叙述性综合方法分析和解释研究结果，其中综合了定量和定性综合。
本研究纳入了三项定性研究、七项观察性研究和四项实验或准实验研究。所有干预前后的家庭调查都报告说，干预后分娩覆盖率增加：与基线相比，干预结束时增加了 4 到 46 个百分点。四项研究中的 7564 名妇女的实验和准实验研究的汇总分析表明，米索前列醇组和对照组的医疗机构分娩率没有显著差异[比值比 1.011；95%置信区间：0.906-1.129]。一项针对卫生专业人员的定性研究也表明，社区分发米索前列醇预防产后出血得到了社区成员和利益相关者的认可，并且这是一种可行的临时解决方案，直到获得医疗机构分娩的机会增加。在社区分发米索前列醇的项目中，在七项涉及 11108 名母亲的研究中，不到 2%的孕妇在分娩前自行服用米索前列醇。证据还表明，大多数使用米索前列醇片的妇女都按照说明使用了这些药物。在审查的研究中都没有药物滥用的不良后果。
没有证据支持社区分发米索前列醇会转移原本会在医疗机构分娩的妇女到家中分娩，并促进药物滥用的说法。因此，在资源有限的环境中，社区分发米索前列醇可以作为减少因产后出血导致的产妇死亡的一种适当策略。
