Intramuscular methergine versus per-rectal misoprostol for prevention of atonic post-partum haemorrhage

Abstract

Background: Postpartum haemorrhage (PPH), is a major hazard of maternal death which is accounting for 30% of deliveries with a 1% mortality rate globally. Present study was designed to compare the efficacy of per rectal misoprostol and intramuscular methergine in the management of 3rd stage labour for prevention of postpartum haemorrhage.Methods: A total four hundred cases with low risk term pregnancy admitted and attending department of obstetrics and gynaecology were considered and were divided in 2 groups such as group 1 consists of 200 patients administered with misoprostol 600µg after delivery and group 2 consists 200 patients administered with methyl ergometrine 0.2mg (intramuscular) after delivery.Results: Methyl ergometrine group had a significant reduction in duration of third stage (p<0.05) and blood loss (p<0.05) when compared to misoprostol group. Need for additional Oxytocics was also more in misoprostol group (8%) as compared to methyl ergometrine group (4%). In group 1 average blood loss was found to be 241.3ml, whereas in group 2 it was 179.3ml. Average Hb levels were significantly reduced in group 2 when compared to group 1 patients. Incidence of side effects like nausea, vomiting is more in methergine group than misoprostol group.Conclusions: Intramuscular methergine results in lower blood loss, reduction in duration of third stage of labour, significantly reduction in hemoglobin level after delivery but is associated with more side effects while per rectal misoprostol is less effective but safe with lesser side effects.

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

“…This difference could be due to different route of administration used for misoprostol. 2 In a study conducted in India oral misoprostol and intravenous methyl ergotamine were used. No difference in reduction of blood loss was found between the two.…”

“…Atony of uterus is implicated in 70% of cases of PPH and sometimes extensive surgical measures are required for its remedial. 1,2 Most tested treatment for atonic postpartum hemorrhage starts with methyl ergotamine, oxytocin and prostaglandins. Though many clinicians use IV Oxytocin to decrease blood loss during third stage but it was seen around half of females required other uterotonic drugs like Ergot Alkaloids or Prostaglandins.…”

“…In another study conducted by Humera in India misoprostol and methyl ergotamine were found to be equally effective. 1,2 The rationale was to conduct a study in our study due to conflicting evidence for determining whether this cheap & widely used misoprostol is better to prevent PPH than Methyl ergotamine which is also one of the favored drug in reduction of blood loss in the third stage of labour.…”

The use of misoprostol as a prevention for post-partum hemorrhage after cesarean ection

“…The prevalence of PPH reached 14 million cases and 70,000 of those cases ended in maternal mortality. Data shows more than 20% of maternal mortality which are caused by PPH (Singangutti, 2018;M. Sweed et al, 2019).…”