Objectives To investigate the effect of oral misoprostol in dosages varying from 200 mg to 800 mg on postpartum uterine contractility and to establish their side effects.Design A prospective descriptive study.Participants Fifty-seven women who delivered vaginally after spontaneous labours not requiring augmentation.Methods Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded. Results There was no statistical difference (P 0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 mg (adjusted mean difference ±2282 kPas s, 95% CI ±7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was signi®cantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P 0.002), but their durations of action were similar (P 0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 388C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women). Conclusion The results of this study show that oral misoprostol has a de®nite uterotonic effect on the postpartum uterus. At doses of 200 mg to 400 mg, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with signi®cantly more side effects.

In 47 women, the change in the uterine activity after the administration of a uterotonic agent was correlated with the amount of blood loss during the same period of time. Uterine activity was measured by a Gaeltec^® catheter-tipped pressure transducer inserted transcervically within 5 min of delivery of the placenta. A uterotonic agent (either intravenous syntocinon, intramuscular syntometrine or oral misoprostol) was given after the insertion of the intrauterine pressure catheter and pressure recorded for another 90 min. Blood loss over the same 2-hour period was collected with absorbent paper which was then assessed by colorimetric measurement of the haemoglobin content in the sample. Our results show that the change in uterine activity is associated with the total blood loss. However, there is a poor linear correlation between the two variables probably because of the biological variation in myometrial activity and differences in coagulation mechanisms in normal women.

The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 microg to 400 microg, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects.

Background: Children of very low birth weight (VLBW, birth weight <1,500g) are at risk of developmental disability and learning difficulties. Regular follow-up to a school-going age allows timely diagnosis and intervention. Methods:The duration, developmental assessment and service utilisation of 41 VLBW children with birth weights between 1,251-1,500g born in 2001 were retrospectively analysed. results:The median follow-up duration was 5 years 11 months. 56% were followed-up till preschool entry. Gross motor, fine motor and language domains were assessed in more than 95% of children. Information on behavioural and learning problems was only sought for in approximately 50% of children.Conclusions: A significant proportion of these high-risk children were either not followed-up long enough or were not adequately assessed for learning and behavioural problems, thus justifying the development of a new standardised follow-up program for larger VLBW children.