Obstetrics & Gynecology

Paper: Risk of fever after misoprostol for the prevention of postpartum hemorrhage: a meta-analysis
Paper authors: Anisa Elati and Andrew Weeks
Paper ref: Vol. 120 No. 5, November 2012

Misoprostol is recommended for post partum haemorrhage due to its potency, ease of administration and cost effectiveness. However, its known side effect of an elevated maternal temperature can cause unnecessary investigations for the mother and even unnecessary antibiotics for the neonate.

This meta-analysis was carried out with the aim to assess the incidence and risk of fever associated with the use of misoprostol and how varying doses and routes of administration affected this. Randomised controlled trials between 1966 and 2012 looking at the prophylactic use of misoprostol against either placebos or other utero-tonics, and the recorded the rate of fever, were reviewed.

The authors are honest in stating the analysis shows a wide variation in fever rates between the 30 articles, which they state could be due to variations in fever definitions (e.g. >38ºC vs other), fever reporting (e.g. routine temperature assessments vs patient-reported fevers only), genetic variation between ethnic groups or even intra-partum clinical factors.  High-dose sublingual routes are overall shown to have the highest incidence of fever, but more specific research appears to be needed before any other answers can be determined.

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