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Coelius RL, Stenson A, Morris JL, Cuomu M, Tudor C, Miller S. The tibetan uterotonic zhi byed 11: mechanisms of action, efficacy, and historical use for postpartum hemorrhage. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2011; 2012:794164. [PMID: 21822444 PMCID: PMC3142552 DOI: 10.1155/2012/794164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/12/2011] [Accepted: 05/25/2011] [Indexed: 11/29/2022]
Abstract
Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients.
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Affiliation(s)
- Rebecca Lynn Coelius
- School of Medicine, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
| | - Amy Stenson
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Center for the Health Sciences, University of California, Los Angeles, 10,833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Jessica L. Morris
- Safe Motherhood Program, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
| | - Mingji Cuomu
- The Institute for Social and Cultural Anthropology, University of Oxford, 386 London Road, Headington, Oxford OX3 8DW, UK
- Tibetan Medical College, Lhasa, Tibet 850000, China
| | - Carrie Tudor
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Suellen Miller
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
- Safe Motherhood Programs, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
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Miller S, Tudor C, Thorsten V, Nyima, Kalyang, Sonam, Lhakpen, Droyoung, Quzong K, Dekyi T, Hartwell T, Wright LL, Varner MW. 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 2009; 54:133-141.e1. [PMID: 19249659 PMCID: PMC2791828 DOI: 10.1016/j.jmwh.2008.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/29/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 50 Beale St., Ste. 1200, San Francisco, CA 94105, USA.
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