The effect of Plantago oral syrup on hemoglobin and hematocrit levels in women with normal postpartum hemorrhage

Document Type : Original Article


1 M.Sc. Student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 B.Sc. in Agricultural Engineering, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Epidemiology, Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.


Introduction: Postpartum hemorrhage is one of the major causes of maternal mortality, especially in the developing countries. Some studies have shown the positive effects of Plantago on postpartum hemorrhage. We conducted this study to determine the effects of Plantago syrup on postpartum hemoglobin and hematocrit levels in low-risk women in terms of postpartum hemorrhage.
Methods: A double-blind, randomized, clinical trial was carried out on all the women who had gone through normal vaginal delivery in Ganjavian Maternity Clinic of Dezful, Iran, in 2017. The participants were randomly assigned to intervention and placebo group (n=50 per group). Immediately after placental expulsion, the intervention group received 100 cc of Plantago extract 20% and infusion of 20 U of oxytocin in 1 L of Ringer’s solution, and the control group was given 100 cc of placebo syrup and infusion of 20 U of oxytocin in 1 L of Ringer’s solution. Hemoglobin and hematocrit levels were measured in all the participants 6 h postpartum. To analyze the data, independent t-test, Fischer’s Exact test, Mann-Whitney U test, Kendall rank correlation coefficient, Chi-squared test, and repeated measures analysis of variance (ANOVA) were run in SPSS, version 17.
Results: There was a significant difference between the two groups in terms of hemoglobin and hematocrit reduction. Before the intervention, the mean levels of hemoglobin and hematocrit in the intervention group were 12.60±3.8 g/dl and 36.69±3.3%, respectively, and in the control group, they were 12.25±1.1 g/dl and 38.06±3.4%, respectively (P>0.005). After the intervention, the mean reduction in hemoglobin level in the intervention and control groups was 1.17±0.4 and 2.19±0.6 g/dl, respectively (P=0.001).
Conclusion: Oral Plantago syrup played a significant role in lowering the mean reduction in hemoglobin and hematocrit levels after delivery. The use of this syrup could help prevent the complications of postpartum anemia.




    1. Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2003; 1:CD003249.
    2. Ghalandari S, Kariman N, Sheikhan Z, Shahrahmani H, Asadi N. Systematic review on variety of effective treatment methods for postpartum hemorrhage in Iran and world. Iran J Obstet Gynecol Infertil 2016; 19(15):16-38. (Persian).
    3. Fakour F, Mirzayi M, Naghipour MR, Ebrahimi H, Mahdavi M. Comparison between sublingual misoprostol and intravenous oxytocin in management of third stage of labor. Iran J Obstet Gynecol Infertil 2012; 15(34):7-14. (Persian).
    4. Winikoff B, Dabash R, Durocher J, Darwish E, Ngoc NT, León W, et al. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial. Lancet 2010; 375(9710):210-6.
    5. El-Hamamy E, B-lynch C. A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe post-partum haemorrhage. J Obstet Gynaecol 2005; 25(2):143-9.
    6. Mojahed S, Aflatunian A, Khadem N, Dehghani Firouzabadi R, Karimi Zarchi M. An investigation into effectiveness of date (Rutab) on postpartum hemorrhage. SSU J 2012; 20(2):159-66.
    7. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the world health organization multicountry survey on maternal and newborn health. BJOG 2014; 121(Suppl 1):5-13.
    8. World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization; 2001.
    9. Tsu VD, Langer A, Aldrich T. Postpartum hemorrhage in developing countries: is the public health community using the right tools? Int J Gynecol Obstet 2004; 85(Suppl 1):S42-51.
    10. Woman Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389(10084):2105-16.
    11. Ahonen J, Jokela R. Recombinant factor VIIa for life-threatening post-partum haemorrhage. Br J Anaesth 2005; 94(5):592-5.
    12. Steinhoff M, Neisius U, Ikoma A, Fartasch M, Heyer G, Skov PS, et al. Proteinase-activated receptor-2 mediates itch: a novel pathway for pruritus in human skin. J Neurosci 2003; 23(15):6176-80.
    13. Samuelsen AB. The traditional uses, chemical constituents and biological activities of Plantago major L. a review. J Ethnopharmacol 2000; 71(1-2):1-21.
    14. Yadegari Z, Amir Ali Akbari S, Sheikhan Z, Nasiri M, Akhlaghi F. The effect of consumption of the date fruit on the amount and duration of the postpartum bleeding. Iran J Obstet Gynecol Infertil 2016; 18(181):20-7. (Persian).
    15. Bazafkan MH, Hardani A, Zadeh MR, Zargar AA, Zadeh MO, Hemmati AA, et al. Wound healing effect of an ointment made from a mixture of brassica oleracea var, punica granatum, and plantago major l extracts in rats. Jentashapir J Health Res 2014; 5(4):e21877.
    16. Ghalandari S, Kariman N, Sheikhan Z, Mojab F, Mirzaei M, Shahrahmani H. Effect of hydroalcoholic extract of capsella bursa pastoris on early postpartum hemorrhage: a clinical trial study. J Altern Complement Med 2017; 23(10):794-9.
    17. Li DH, Han T, Guan LP, Bai J, Zhao N, Li ZL, et al. New naphthopyrones from marine-derived fungus Aspergillus niger 2HL-M-8 and their in vitro antiproliferative activity. Nat Prod Res 2016; 30(10):1116-22.
    18. Dettori J. The random allocation process: two things you need to know. Evid Based Spine Care J 2010; 1(3):7-9.
    19. Mahdavian M, Golmakani N, Mansoori A, Hoseinzadeh H, Afzalaghaee M. An investigation of effectiveness of oral Dill extracts on postpartum hemorrhage. J Women Midwifery Infertil Iran 2001; 78(4):19-26.
    20. Hagerman AE, Riedl KM, Jones GA, Sovik KN, Ritchard NT, Hartzfeld PW, et al. High molecular weight plant polyphenolics (tannins) as biological antioxidants. J Agric Food Chem 1998; 46(5):1887-92.