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Misoprostol - brand name Cytotec - is used to to prevent life-threatening bleeding in women after giving birth in community settings in low income countries. But now, the effectiveness of the drug is raising some eyebrows. 

University of London researchers have said that there is insufficient evidence for the effectiveness of the drug that is being used increasingly to prevent life-threatening bleeding in women after giving birth. 

 The review is published in the Journal of the Royal Society of Medicine. 

Misoprostol was originally developed for treating gastric ulcers, and is increasingly used in low- and middle-income countries for preventing postpartum hemorrhage (PPH). The drug is included on the World Health Organization's Essential Medicines List for this use.

The researchers identified 172 studies on the use of misoprostol during labor and found that only six had enough information to enable them to review whether or not the drug was effective in preventing PPH in rural and community settings in low income countries. 

Countries such as Nepal, India and Uganda are promoting and using misoprostol.

The six studies failed to provide sufficient evidence that the drug worked and most had problems with study design and the fact the findings were not applicable generally.

Researchers said current evidence to support the use of misoprostol in home or community settings in low- and middle-income countries for the prevention of postpartum hemorrhage is inconclusive. 

According to the researchers, misoprostol is popular in developing countries because it is a fairly stable drug that does not degrade if not kept in cold storage conditions. It also does not have to be given intravenously. 

Researchers said the money being spent on buying misoprostol could be used to to get skilled attendants during delivery and adequate pre-natal services that can detect and help to prevent complications.

Researchers said developed countries would not give women misoprostol during labour on the basis of the current evidence, yet industry and health practitioners are pushing it hard in developing countries.

In 2008, most of the 342,900 deaths related to pregnancy and childbirth in took place in developing countries. About 25 percent of those deaths were linked to PPH while giving birth.

The main risk factor for PPH is anaemia, which is easily treated if it is diagnosed. But without pre-natal screening, it is impossible to identify women who may have developed it and who are at increased risk of life-threatening bleeding during labour.

The researchers are urging the WHO to urgently review its decision to put misoprostol on its Essential Medicines List.