Misoprostol or cytotec has several applications.  It is currently being
evaluated for the treatment of postpartum hemorrhage.  This isn't a huge
concern yet for those of us living in places with easy access to
professional care when giving birth, short distance to hospital, and an
abundance of supplies such as oxytocin for injection or infusion and the
equipment to administer it.
Most women who die in connection with childbirth, and there are many such
deaths every single day, bleed to death.  Most of them have had no care.
They live in places where there may not be roads, or the community may not
value their lives enough to send them on the roads that exist, or they may
lack the money to pay for transport and/or care if it is available at all.
The provision of medications to prevent hemorrhage, and indeed to conserve
blood in women already anemic, is now dependent on IV administration
equipment and skills, with resulting waste disposal problems and risk of
needle stick injuries with potential spread of blood-borne disease.
Methergine requires refrigeration in addition, and has a good many side
effects.  It is also not effective for acute hemorrhage if given orally,
needles again.  Misoprostol appears to have potential to save mothers' lives
in this real world scenario.  It is easier to store and easier to administer
than the other drugs.

The research shows that misoprostol is effective for the induction of labor.
It doesn't show whether it is generally better or worse than other methods
currently in use.  Whether, and when, to induce labor is a separate issue.
The research also shows that there seems to be an increased risk of uterine
rupture when misoprostol is used to induce labor in women with previous
uterine surgery, compared with prostaglandin gels and oxytocin infusion.
The info from the manufacturer advising against the use of misoprostol in
pregnant women is plain and simple 'C.Y.A.' as it has not been approved for
this use.  As someone else pointed out, we use other drugs for things they
are neither tested nor approved for.
To do a handspring back ON topic:
A mother who has died of postpartum hemorrhage leaves behind a baby who
likely will not be breastfed, and as PPH is more common among multiparous
women, there are usually other children too, and the whole community bears
the loss.
Rachel Myr
Kristiansand, Norway
who supports the use of appropriate technology in childbirth and who
realizes that too much technology is just as bad as too little.

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