A comparative study of different route of administration of misoprostol in the management of third stage of labour

Abstract

INTRODUCTIONThird stage of labour begins after the delivery of the fetus till the expulsion of the placenta and membranes. 1 Though the third stage constitutes short span of time, it is the phase of maximum maternal mortality and morbidity.One of the major hazards being post partum haemorrhage. PPH complicates approximately 4% of vaginal deliveries and 6% of caesarean deliveries. WHO statistics suggest 30% of maternal deaths worldwide with an estimated 1.25 million cases and morbidity in 20 million women annually are due to PPH. 2,3Uterine atony is the most common cause constituting about 80-90% of cases.4 So, we have to aim at increasing the tone of the uterus by using uterotonic drugs to reduce PPH. Various uterotonic drugs is available like Oxytocin, Ergometrine, Prostaglandins.5 To prevent and treat PPH, literature strongly suggests the use of active management of 3rd stage 6 which includes use of Oxytocin at the time of delivery of anterior shoulder, controlled cord traction, ABSTRACT Background: Post partum haemorrhage is the most common cause of maternal morbidity and mortality. Misoprostol is a prostaglandin analogue, used for management of post partum haemorrhage. It can be used by various routes with minimal side effects. This study is done to compare the different routes of administration of Misoprostol for the third stage management and their side effects. Objectives of present study were to estimate the amount of blood loss, to assess the maternal side effects of drug, to know the haemoglobin deficit, to know the duration of third stage of labour. Methods: This was a prospective hospital base study of 150 women delivery at obstetrics and gynaecology department at ESICMC Model Hospital, Rajajinagar. They were randomized into 3 groups of 50 patients each. They received 400 µg of misoprostol either orally or rectally or sublingually immediately after delivery of the fetus. The primary outcomes analysed were amount of blood loss duration of third stage of labour haemoglobin deficit and their side effects Results: The amount of blood loss and haemoglobin deficit was least in sublingual group which was statistically significant. Need of additional oxytocics was less in sublingual and oral group, though it was not statistically significant. Conclusions: In the present study, sublingual Misoprostol was found to be more effective in reducing blood loss during third stage of labour.