Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet

J Midwifery Womens Health. Mar-Apr 2009;54(2):133-141.e1. doi: 10.1016/j.jmwh.2008.09.010.


The objective of this study was to compare a Tibetan traditional medicine (the uterotonic Zhi Byed 11 [ZB11]) to oral misoprostol for prophylaxis of postpartum hemorrhage (PPH). We conducted a double-blind randomized controlled trial at three hospitals in Lhasa, Tibet, People's Republic of China. Women (N = 967) were randomized to either ZB11 or misoprostol groups. Postpartum blood loss was measured in a calibrated blood collection drape. The primary combined outcome was incidence of PPH, defined as measured blood loss (MBL) > or = 500 mL, administration of open label uterotonics, or maternal death. We found that the rate of the combined outcome was lower among the misoprostol group (16.1% versus 21.8% for ZB11; P = .02). Frequency of PPH was lower with misoprostol (12.4% versus 17.4%; P = .02). There were no significant differences in MBL > 1000 mL or mean or median MBL. Fever was significantly more common in the misoprostol group (P = .03). The rate of combined outcome was significantly lower among women receiving misoprostol. However, other indices of obstetric hemorrhage were not significantly different.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Carbonates
  • Double-Blind Method
  • Female
  • Humans
  • Medicine, Tibetan Traditional*
  • Misoprostol / adverse effects
  • Misoprostol / therapeutic use*
  • Oxytocics / adverse effects
  • Oxytocics / therapeutic use*
  • Phytotherapy
  • Plant Preparations / therapeutic use*
  • Plants, Medicinal
  • Postpartum Hemorrhage / prevention & control*
  • Pregnancy
  • Snakes
  • Sulfur
  • Tibet
  • Young Adult


  • Carbonates
  • Oxytocics
  • Plant Preparations
  • Misoprostol
  • Sulfur