Publication: Rectal Misoprostol versus Intramuscular Oxytocin for Prevention of Post Partum Hemorrhage
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Date
2011
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and
mortality especially in the developing countries.,Compared to expectant management,
active management decreases the incidence of PPH.
Objective
To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the
prevention of postpartum hemorrhage.
Methods
This is a prospective, randomized and analytical study from 1stSeptember 2009 to
28th February 2010 at Department of Obstetrics and Gynecology, Dhulkhel Hospital -
Kathmandu University Hospital, Dhulikhel, Nepal. A total of 200 women were included
to receive either 1000 micrograms rectal misoprostol tablets or 10 units of oxytocin
intramuscularly. Primary outcome measures were the incidence of postpartum
hemorrhage or a change in hematocrit or hemoglobin from admission to day two
post delivery. Secondary outcome measures including severe postpartum hemorrhage
and the duration of the third stage of labor were noted. Also the side effects of both
misoprostol and oxytocin were recorded.
Results
The frequency of postpartum hemorrhage was 4% in the misoprostol subjects and 6%
in the control subjects (P=0.886) There were no significant difference among the groups
in the drop of hematocrit (P>0.05). Secondary outcome measures including severe
postpartum hemorrhage and the duration of the third stage of labor were similar in
both groups. Similarly, the side effects between the misoprostol and oxytocin group
within 6 hours was statistically significant (p=0.003) whereas the side effects within
24hours was statistically not significant (p=0.106).
Conclusion
Rectal misoprostol is as effective as intravenous oxytocin in preventing postpartum
hemorrhage with the similar incidence of side effects and is worthwhile to be used as a
uterotonic agent for the routine management of third stage of labor.
KEY WORDS
misoprostol, oxytocin, postpartum hemorrhage
Description
Shrestha A,1 Dongol A,1 Chawla CD,1 Adhikari R2
1Department of Obstetrics and Gynecology,
2Department of Community Medicine Kathmandu University School of Medical Sciences – Dhulikhel Hospital, Kavre, Nepal