Aims Insufficient evidence exists regarding the prevention of postpartum haemorrahge (PPH) by oral administration of misoprotol in low income countries. This study investigates whether 400 μg of oral misoprostol could prevent PPH in a community home-birth setting and to assess its acceptability and feasibility among rural Bangladeshi women.

Methods This quasi-experimental trial was conducted among women who had home delivery between November 2009 and February 2010 in two rural districts of Bangladesh. Two treatment arms included intervention group (n=1009) receiving 400 μg of misoprostol immediately after birth, and control group (n=1008) without misoprostol. Primary PPH was measured by women's self-reported subjective measures of the normalcy of blood loss using the “cultural consensus model.” Baseline data provided socioeconomic, reproductive, obstetric, and bleeding disorder information.

Findings The incidence of primary PPH was found to be lower in the intervention group (1.6%) than the control group (6.2%) (p<0.001). Misoprostol provided 83% protection (OR 0.17; 95% CI 0.05 to 0.54) from developing primary PPH. Women in the control group were more likely to need an emergency referral to a higher level facility and blood transfusion than the intervention group. Few women experienced transient side-effects of misoprostol. Eighty seven per cent of the women were willing to use misoprostol in their future pregnancy, and would recommend to other pregnant women.

Conclusion Community based distribution of oral misoprostol (400 μg) appeared to be as effective, safe, acceptable, and feasible in preventing PPH in rural Bangladesh. This strategy may be scaled up across the country where access to skilled attendance is limited.