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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Public Health/Global Health

Poster Session 1

(379) Effect of Misoprostol Reclassification as a Schedule IV Drug on Postpartum Hemorrhage Management

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
On October 1st, 2024, Louisiana Act 246 went into effect, re-classifying misoprostol and mifepristone as Schedule IV controlled substances. Misoprostol is frequently used for management of postpartum hemorrhage. We investigated how this reclassification affects management of postpartum hemorrhage (PPH).

Study Design:
We performed a retrospective cohort study of all deliveries in a large regional health system from July 1, 2024, to January 1, 2025, comparing deliveries prior to and after enactment of Act 246. Patients who experienced a PPH (quantitative blood loss [QBL] >1000cc) were included. The primary outcome was use of misoprostol for management of PPH. Secondary outcomes included use of other uterotonic medications, QBL, intrauterine vacuum or tamponade device usage, severe maternal morbidity and mortality (SMM), transfusion, ICU admission, and change in hemoglobin/hematocrit. Chi-Square test was used to determine relative risk with 95% confidence intervals.

Results:
There were 748 deliveries complicated by PPH during the study period, 380 occurred prior to and 368 deliveries occurred after Act 246 enactment. There was no difference in misoprostol use for management of postpartum hemorrhage before and after Act 246 enactment (RR 1.02, 0.88-1.18). There was no difference in the use of methylergometrine (RR 0.93, 0.80-1.07), carboprost (RR 1.01, 0.85-1.20), PPH devices (RR 1.07, 0.82-1.40), SMM (RR 0.86, 0.57-1.29), transfusion (RR 1.03, 0.85-1.26), ICU admission (RR 0.91, 0.51-1.65), or total interventions required (p=0.104). Administration of tranexamic acid increased after Act 246 enactment (RR 1.19, 1.03-1.38).

Conclusion:
After reclassification of misoprostol as a schedule IV drug, use of tranexamic acid for management of postpartum hemorrhage increased. The use of misoprostol, other uterotonic medications, and PPH devices was unchanged. This highlights the importance of developing processes to ensure ready access to medications in the event that restrictive laws become enacted.