Low‐dose sublingual misoprostol versus methylergometrine for active management of the third stage of labor

Chhabra, Shakuntala; Tickoo, Chandan

doi:10.1111/j.1447-0756.2008.00843.x

Cited by 17 publications

(13 citation statements)

References 14 publications

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“…This cut‐off value was based on reports of a mean pre‐delivery haemoglobin of 9.8 g/dl among women in India 14, 15, 16. A drop to 7.8 g/dl would approximate a clinically relevant 2 g/dl decrease in pre‐ to post‐delivery haemoglobin and is below the value considered indicative of moderate to severe anaemia (9.0 g/dl) 17.…”

Section: Methodsmentioning

confidence: 99%

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Raghavan

Geller

Miller

et al. 2015

BJOG

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ObjectiveTo assess whether secondary prevention, which preemptively treats women with above‐average postpartum bleeding, is non‐inferior to universal prophylaxis.DesignA cluster‐randomised non‐inferiority community trial.SettingHealth sub‐centres and home deliveries in the Bijapur district of Karnataka, India.PopulationWomen with low‐risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub‐centre and who consented to be part of the study.MethodsAuxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour.Main outcome measuresPostpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher‐level facilities, acceptability and feasibility of the intervention.ResultsMisoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference −2.9%, one‐sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013).ConclusionSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level.Tweetable abstractSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis.

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Section: Methodsmentioning

confidence: 99%

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Raghavan

Geller

Miller

et al. 2015

BJOG

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“…Hemoglobin reduction was similar in both the groups, similarily found by few others. 1,6 Side effects of misoprostol are shivering, nausea, vomiting, pyrexia and diarrhea.…”

Section: Discussionmentioning

confidence: 99%

“…3,5 Use of prostaglandins in postpartum period was first described in 1976. 3 El-Raphey et al first reported use of misoprostol in third stage of labor, 1,5 since then so many reports revealed that misoprostol is effective in active management of third stage of labor by various routes like sublingual, oral, rectal and vaginal. It is stable at room temperature has very long shelf life and easy to administer, hence it could be a ideal alternative for active management of third stage for rural and peripheral areas.…”

Section: Introductionmentioning

confidence: 99%

“…Methylergometrine/ oxytocin need maintenance of cold chain as well as syringes, needles, training and licencing. 1,4,5 Furthermore ergometrine is known to induce hypertension, vomiting and contraindicated in pregnancy-induced hypertension and heart disease. 3,5 Use of prostaglandins in postpartum period was first described in 1976.…”

Section: Introductionmentioning

confidence: 99%

“…approximately 25% in rural areas, 1,2 as these women are more vulnerable for even normal amount of blood loss because of being anemic and malnourished. 1 Although prophylactic use of uterotonics in third stage of labor are routine, the preparations used vary from center to center; oxytocin, ergometrine or a mixture of oxytocin and ergometrine are used, alongwith early suckling of breast. 3 In our hospital, we use methylergometrine 200 µg intravenously as a routine with the delivery of anterior shoulder.…”

Section: Introductionmentioning

confidence: 99%

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Sublingual 400 μg Misoprostol vs Intravenous 0.2 mg Methylergometrine for Active Management of Third Stage of Labor

Bhute¹,

Shrivastava²,

Khamsara³

et al. 2013

Journal of South Asian Federation of Obstetrics and Gynaecology

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Objectives: To compare the efficacy and side effects of sublingual 400 µg misoprostol with 0.2 mg intravenous methylergometrine in active management of third stage of labor. Materials and methods:In a prospective, randomized comparative study conduted in Department of Obstetrics and Gynecology, AVBRH, Wardha, 200 women at full-term gestation, without any high risk factors were studied in two groups of 100 each, for safety and efficacy of 400 µg sublingual misoprostol in comparison to 0.2 mg intravenous methylergometrine at the delivery of anterior shoulder from December 2010 to November 2011. Main parameters used were duration of 3rd stage, amount of blood loss, need of aditional uterotonic, complications of third stage, drop in hemoglobin and side effects. Results were analyzed by Student's t-test.Results: Mean duration of third stage in misoprostol group was 9.67 ± 1.98 min, amount of blood loss was 203 ± 24 ml, need of additional uterotonics was 13%, drop in hemoglobin 0.59 ± 0.79 which were almost comparable with other group and side effects were mainly shivering and pyrexia in misoprostol group and vomiting and giddiness in methergine group. Conclusion:Sublingual 400 µg misoprostol is almost equally effective as intravenous methergine for active management of third stage of labor with advantage of simplicity of storage of drug, route of administration and no risk of injection associated infections, which make it very much relevant in rural scenario.

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Prostaglandins for preventing postpartum haemorrhage

Gülmezoglu

Forna

Villar

et al. 2007

Cochrane Database of Systematic Reviews

122

114

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Low‐dose sublingual misoprostol versus methylergometrine for active management of the third stage of labor

Cited by 17 publications

References 14 publications

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Sublingual 400 μg Misoprostol vs Intravenous 0.2 mg Methylergometrine for Active Management of Third Stage of Labor

Prostaglandins for preventing postpartum haemorrhage

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