Management of severe postpartum hemorrhage with misoprostol

Abdel‐Aleem, Hany; Elnashar, I.; Abdelaleem, Ahmed A.

doi:10.1016/s0020-7292(00)00321-0

Cited by 34 publications

(12 citation statements)

References 2 publications

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“…All doctors appreciate the facility of use ( Table 2). PPH was stopped in 50% of the patients who received misoprostol suppository, which is in agreement with published studies [11][12][13][14][15][16]32]. The number of patients should be increased in a future study to evaluate to a larger extent the efficacy of this suppository versus tablet in the treatment of PPH.…”

Section: Facility Of Usesupporting

confidence: 86%

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Development of Misoprostol Suppositories for Postpartum Hemorrhage

Constantin

Zelger²,

Paroz³

et al. 2013

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Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpose, 1000 μg intrarectal (insertion of five 200 μg tablets) has been recommended as the third line after injectable oxytocin and methylergometrine. We proposed to manufacture a 1000 μg misoprostol suppository by determining formulation, release and stability. The administration facility was also evaluated. Several formulations of misoprostol suppositories were set up and evaluated. Misoprostol tablets and lipophilic bases (Hard fat-Adeps solidus Ph. Eur., Witepsol ® H15 and Suppocire ® AM and AS 2 X) were used to obtain suppositories. Surfactants were also tested (polysorbates Tween ® 20, Tween ® 80 and sodium lauryl sulfate (SLS)). The formula was monitored by the misoprostol release curve with an in vitro test and dosed by a HPLC method. Stability was determined by evaluating the percentage of misoprostol content remaining over the time in suppositories stored at 4˚C and 25˚C. Facility of use versus tablets was evaluated by obstetricians of a Swiss regional hospital using a questionnaire. Misoprostol release was facilitated by adding surfactant to the lipophilic base. After 30 minutes, 59% ± 1.4% and 57% ± 8.2% of misoprostol was released with Adeps solidus + 1% SLS and Adeps solidus + 5% Tween 20 respectively. SLS was discarded to the final formula because of its irritating effect. After 7 months, suppositories still contained 94% ± 3.7% misoprostol with storage at 4˚C. The administration was considered easier and faster compared with intra rectal use of tablets. The formula, consisting of 5 crushed misoprostol tablets dispersed in a suppository base made of Adeps solidus + 5% Tween ® 20, is stable for at least 7 months at 4˚C and facilitates the rectal administration of misoprostol in the treatment of PPH.

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Section: Facility Of Usesupporting

confidence: 86%

“…Since 1987, misoprostol has been used to prevent or treat PPH in doses up to 600 µg in oral or sublingual administration [8][9][10] and up to 1000 µg rectally [11][12][13][14][15][16]. Misoprostol tablet can also be absorbed by both rectal and vaginal routes [17].…”

Section: Introductionmentioning

confidence: 99%

Development of Misoprostol Suppositories for Postpartum Hemorrhage

Constantin

Zelger²,

Paroz³

et al. 2013

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“…Une étude récente a montré la supériorité du misoprostol par voie rectale par rapport à l'association de l'ocytocine à l'ergométrine dans le traitement des hémorragies de la délivrance [5]. Plusieurs auteurs semblent également suggérer son bénéfice dans la prise en charge des atonies utérines [6][7][8][9], mais il s'agit de séries préliminaires. En France, il est de plus en plus utilisé dans les maternités pour la gestion des hémorragies du postpartum, mais son emploi reste peu évalué.…”

Section: Introductionunclassified

Le misoprostol par voie rectale dans l'hémorragie de la délivrance

Shojai

Desbrière

Dhifallah

et al. 2004

Gynécologie Obstétrique & Fertilité

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“…In the literature, two case reports, two observational studies and a singleblinded randomised study support the use of misoprostol in the treatment of PPH (n=66; Table 1) [15][16][17][18][19]. In the study of Lokugamage et al [19] misoprostol per rectum was significantly better compared with Syntometrine intramuscularly or Oxytocin intravenously in the treatment of primary PPH.…”

Section: Treatmentmentioning

confidence: 96%