Derman, Richard J., Kodkany, Bhalchandra S., Goudar, Shivaprasad S., Geller, Stacie E., Naik, Vijaya A., Bellad, M B., Patted, Shobhana S., Patel, Ashlesha, Edlavitch, Stanley A., Hartwell, Tyler, Chakraborty, Hrishikesh, and Moss, Nancy
The commonest cause of maternal deaths worldwide is postpartum bleeding, and the great majority of such deaths take place in developing countries such as India where women frequently do not deliver their children in a hospital setting. The major cause is uterine atony, which can be prevented by administering a uterotonic agent such as oxytocin. Such treatment remains impractical for much of the developing world, where women giving birth are cared for by untrained attendants. In addition, injected uterotonic agents must be stored in the cold and require active management of the third stage of labor. Orally administered misoprostol, a prostaglandin E1analogue, is a comparatively inexpensive alternative to oxytocin that has proved to be effective and safe, does not need to be refrigerated, and has a long shelf life.