The drug misoprostol was developed to treat gastric ulcer, a break in the normal tissue that lines an individual's stomach. It is widely used in low to middle income countries to prevent postpartum hemorrhage (PPH) in women. However, new research reveals that there is not enough evidence to support the effectiveness of the drug.

Researchers led by Professor Allyson Pollock from the Centre for Primary Care and Public Health at Queen Mary, University of London, found that of 172 studies on the use of misoprostol during labor, only six cases had enough information to assess the effectiveness of the drug in preventing PPH. The six studies were unsuccessful at providing adequate evidence that the drug worked.

"Current evidence to support the use of misoprostol in home or community settings in low- and middle-income countries for the prevention of postpartum haemorrhage is, at best, inconclusive," Pollock said.

Though there is not proper evidence to support the effectiveness of misoprostol, the World Health Organization currently has misoprostol on the Essential Medicine List. Additionally, the drug is being promoted by networks of global public-private partnerships and industries in low and middle income countries, such as Nepal, India and Uganda.

WHO estimates there were 342,900 pregnancy-related deaths in 2008, many of these deaths occurring in developing countries. Of those deaths 25 percent were linked to PPH. The main risk for PPH is anaemia, which can be easily treated if diagnosed.

"The most effective preventive strategy for PPH is prevention of anaemia, good antenatal care including good hygiene and sanitation and good care during labour," Pollock said. "Developed countries would not dream of giving women misoprostol during labor on the basis of the current evidence, yet industry and health practitioners are pushing it hard in developing countries."

According to Pollock the main reason misoprostol is common in developing countries is because it is a fairly stable drug that doesn’t degrade if not stored in cold conditions, and does not have to be given intravenously.

Pollock recommends WHO reviews its decision to put misoprostol on its Essential Medicines List.

"Countries should be concentrating on improving their primary care facilities, rather than thinking there is a pill to prevent every ill," said Professor Pollock. "Misoprostol is being used inappropriately at present, and the money being spent on purchasing the drug would be better spent elsewhere, for instance, in ensuring there are skilled attendants during delivery and adequate antenatal services that can detect and help to prevent complications."

This study was published in the Journal of the Royal Society of Medicine.