Clinical guidelines-the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Abstract

Objective: To establish whether national guidelines for postpartum hemorrhage (PPH) reflect new scientific evidence on misoprostol, and determine the challenges faced in their implementation.

Methods: A web-based survey was sent by email to 130 national societies of obstetrics and gynecology (FIGO Member Associations) in 2016. The survey, composed of 18 questions, covered national guidelines on PPH with particular reference to misoprostol, the creation of national guidelines, and challenges to implementation.

Results: Completed surveys were received from 69 societies, for a 53% response rate. The key findings were that many countries lacked comprehensive, up-to-date, evidence-based national guidelines providing guidance on misoprostol use; recommended regimens were very different in the national guidelines as well as between international and regional guidelines that are most often used as referencing documents; and there are a variety of challenges to implementation of guidelines.

Conclusion: There is a need, especially in countries with high maternal mortality, to establish mechanisms that ensure the existence of up-to-date, comprehensive, evidence-based guidelines on PPH. This can be difficult given conflicting guidance at the international level. Regional and international societies should prioritize clinical updates and ensure their dissemination and implementation.

Keywords: Misoprostol; PPH; PPH guidelines; Postpartum hemorrhage.