DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20171658

Randomized controlled trial of rectal misoprostal and intramuscular oxytocin in the prevention of PPH

Savitha A., Sarita H., Kashinath Gumma

Abstract


Background: PPH accounts for merely 23% of maternal mortality in developing countries.  Misoprostol is a uterotonic agent and is a PGE analogue commonly used in management of PPH. Oxytocin is another uterotonic agent which is now been introduced as intramuscularly effective agent to prevent PPH.This study aims to compare rectal misoprostol with intramuscular oxytocin in reducing blood loss in third stage of labor to prevent PPH. Objective of present study is to compare the clinical effect of rectal misoprostol with intramuscular oxytocin in prevention of PPH.

Methods: A randomized study was conducted over duration of 3 months, at Department of OBG, BRIMS, Bidar, Karnataka, India. Patients with singleton pregnancy with the history of one previous LSCS and opting for elective LSCS were included in the study. Patients with risk pregnancy, such as pre eclampsia, cardiac disease and asthma or grand multipara were excluded from the study. Immediately after spinal anesthesia rectal misoprostol was given while oxytocin was administered after delivery of the baby. Incidence of PPH and amount of blood loss was observed and compared.

Results: The difference in both the groups with regard to mean amount of blood loss, mean duration of the third stage of labor, and mean amount of fall in hemoglobin level was not statistically significant as P value was >0.05. The incidence of PPH and the need for additional oxytocic are slightly more in the misoprostol group. The incidence of shivering and pyrexia was more in the misoprostol group, but not so disturbing so as to lead to disuse of this drug.

Conclusions: Oral misoprostol, though not a replacement of parenterally administered oxytocin, can be used safely in all deliveries for the prevention of postpartum hemorrhage.


Keywords


Misoprostol, Oxytocin, PPH

Full Text:

PDF

References


Andolina K, Daly S, Roberts N, Tolosa J, Wapner R. Objective measurement of blood loss at delivery. Is it more than a guess? Am J Obstet Gynecol. 1999;180:S69.

Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199:519.

Dildy GA. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002;45(2):330-44.

Oboro VO, Tabowei TO. A randomized controlled trial of misoprostol versus oxytocin in the active management of the third stage of labour. J Obstet Gynaecol. 2003;23:13-6.

Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostolwith oral or vaginal administration. Obstet Gynecol. 1997;90(1):88-92.

Arvidsson C, Hellborg M, Gemzell-Danielsson K. Preference and acceptability of oral versus vaginal administration of misoprostol in medical abortion with mifepristone. Eur J Obstet Gynecol Reprod Biol. 2005;123(1),87-91.

Winikoff B, Dabash R, Durocher J, Darwish E, Nguyen TN, 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, randomized, non-inferiority trial. Lancet. 2010;375:210-6.

Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomized controlled trial. Lancet. 2006;368:1248-53.

Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B. Prevention of postpartum hemorrhage with misoprostol. Int J Gynecol Obstet. 2007;99:198-201.

Chong YS, Chua S, Arulkumaran S. Severe hyperthermia following oral misoprostol in the immediate postpartum period. Obstet Gynecol. 1997;90(4)703-4.

Gulmezoglu AM, Villar J, Ngoc NT, Piaggio G, Carroli G, Adetoro L et al. WHO multicentre randomized trial of misoprostol in the management of the third stage of labour. Lancet. 2001;358:689-95.

Blum J, Winikoff B, Raghavan S, Dabash R, Ramadan MC, Dilbaz B. Treatment of post-partum haemorrhage with misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double-blind, randomized, noninferiority trial. Lancet. 2010;375:217-23.