Preventing Postpartum Hemorrhage: Comparing Zb11, A Traditional Tibetan Medicine, To Misoprostol

OBJECTIVES: To emphasize the importance of finding culturally acceptable and effective uterotonics for prevention of postpartum hemorrhage (PPH) by comparing a traditional Tibetan Medicine, Zhi Byed 11 (ZB11), to oral misoprostol.METHODS: Eight published randomized controlled trials (RCTs) of oral misoprostol (600 mcg) versus placebo or other oral uterotonics were identified. Rates and frequencies of PPH, means/medianblood loss, length of third stage of labor (TSL), and side effects were compared with ZB11. Odds ratios (ORs) were created to represent the approximate reflection of ZB11 versus placebo on blood loss.RESULTS: Rates of postpartum blood loss. 1,000 ml with ZB11 was 3.1% compared to misoprostol (range 0.2%-9%). Blood loss. 500 ml was higher with ZB11 (17% compared to 6.4%-16.5%); mean and median blood loss did not differ; length of TSL was shortest for ZB11. Side effects of ZB11 were lower than misoprostol but higher than placebo. Using a statistical approximation of the OR of ZB11 compared to placebo, the theoretical effect suggests that ZB11 has the potential to reduce PPH.CONCLUSIONS: Comparison of outcomes between ZB11 and misoprostol/placebo indicates that ZB11 may be an effective, acceptable uterotonic. Potential alternative uterotonics from different medical traditions, cultures, and regions are suggested for evaluation.