This randomized controlled community-based trial will assess the effectiveness of administration of 800 mcg sublingual misoprostol with standard of care vs. placebo with standard of care for postpartum hemorrhage treatment at the community level, primarily home births attended by primary health care unit (PHU) staff in Etay El Barood and Kafr El Dawar districts (El Beheira governorate), Egypt. Standard of care per national guidelines in this setting is referral to a higher level health facility.
Hospital-based clinical trials have demonstrated misoprostol to be a safe and effective treatment option for postpartum hemorrhage (PPH). Additional research is needed to demonstrate how these findings translate into program effectiveness at lower levels of the health care system, including community home births, where access to skilled providers and treatment options are limited and misoprostol could potentially have the greatest impact on maternal health outcomes. This randomized controlled community treatment trial will assess the effectiveness of misoprostol with standard of care (i.e., referral to higher level care) vs. placebo with standard of care for PPH treatment at the community level, primarily home births attended by primary health care unit staff in Etay El Barood and Kafr El Dawar districts (El Beheira governorate), Egypt. This research will help guide decisions on how to introduce misoprostol into PPH care programs in different contexts such as primary care settings, including community-based home births.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
82
800 mcg of sublingual misoprostol (four tablets of 200 mcg misoprostol) + standard of care (referral to higher level care)
Placebo (4 tablets resembling misoprostol) + standard of care (referral to higher level care)
Prinary Health Units
Etay El Barood and Kafr El Dawar Districts, Beheira, Egypt
Change in hemoglobin measurement of >2 g/dL pre- to -post-delivery.
Proportion of women with a change in hemoglobin of \>2 g/dL pre- to post-delivery, as measured by the HemoCue machine at both time points.
Time frame: Before delivery (at onset of labor), after delivery (2 to 4 days after delivery)
Proportion of women transferred to higher level care
Proportion of women transferred to higher level care will be compared. The condition of the woman at time of transfer and arrival will also be noted.
Time frame: Within 2 to 4 days after delivery
Proportion of women receiving additional interventions to treat PPH
Proportion of women who receive any additional intervention (e.g. uterotonics, manual removal of placental fragments, bimanual compression, IV fluids given, surgical procedures, blood transfusion, etc.) provided either at deliver site or upon transfer to district hospital.
Time frame: Within 2 to 4 days after delivery
Proportion of women with side effects
Proportion of women with observed side effects (including shivering/chills, fever, nausea, diarrhea or fainting). Reported severity of side effects (classified by provider as "mild, "moderate," "severe," ), duration of side effects and proportion of of women receiving additional care to manage side effects will also be assessed.
Time frame: Within 24 hours of delivery
Cost-effectiveness
A cost-effectiveness analysis will be done to compare the two treatment arms. The analysis will factor in the cost of materials used, procedures/interventions performed, transfers, and training of providers.
Time frame: Within 2 to 4 days after delivery
Proportion of women for whom intervention was correctly administered
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Proportion of women for whom treatment was administered as described in protocol (referral initiated and tablets administered to woman after PPH diagnosis made)
Time frame: Within 1 hour of PPH diagnosis