MISOP ROSTOL : AN ALTERNATIVE TO OXYTOCIN IN MANAGEMENT OF 3 rd STAGE OF LABOUR IN RURAL INDIA??

Abstract

ARTICLE INFO ABSTRACTBackground: Postpartum haemorrhage is a life-threatening obstetricemergency that occurs after normal vaginal delivery or caesarean section. Prevention of PPH can be achieved by active management of the third stage of labour in most of the cases. Various uterotonic agents play major role in prevention of PPH. Objective: To compare efficacy of oxytocin 10 IU intramuscular and misoprostol 800µg per rectally in active management of the third stage of labor and determine duration of the third stage of labor, blood loss, effect on haemoglobin of the patient, adverse effects and need for additional uterotonics in both group. Study methods: A prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Kanwatiya Hospital, SMS Medical College, Jaipur(Rajasthan) from December 2016 to February 2017. Active management of 3rd stage of labor was done by using either inj. Oxytocin 10 IU or tab. Misoprostol 800µg as per the group of the patient. Duration of the third stage of labor,the amount of blood loss, the incidenceof postpartum haemorrhage, a drop in haemoglobinconcentration from predelivery to 24 h after delivery and adverse effect of drugs were measured. Results: Demographic characteristics were similar in each treatmentgroup. There was no significant difference between treatment groups in decrease in hemoglobin (oxytocin 0.7 g/dL, misoprostol 0.8 g/dL). Duration of 3 rd stage of labor was slight more with misoprostol group.The significant side effect was shivering and fever, which were more common in the misoprostol group (shiveringmisoprostol 14% vs. oxytocin 5% and (fever -misoprostol 6% vs. oxytocin 1%). Conclusion: Rectal misoprostol 800µg is as effective as 10 IU intramuscular oxytocin in minimizing blood loss in the third stage of labour. Rectal misoprostol has a lower incidence of side effects which are self limiting. This supports the utility of misoprostol as a safe and effective uterotonic for use in the rural and remote areas of developing countries where other pharmacologic agents may be less feasible.