Misoprostol compared with methylergometrine for the prevention of postpartum haemorrhage: a double–blind randomised trial

Abstract

Objective To compare the efficacy and side effects of misoprostol, compared with methylergometrine, Design A double-blind, randomised clinical trial of 200 women with apparently normal pregnancies.Setting University teaching hospital.Participants Two hundred women with apparently normal pregnancies.Methods After the baby had been born, all women received two capsules by mouth and the contents of an ampule by intravenous injection. Each woman only received one active product. The capsules contained either a total of 600 pg misoprostol or placebo, and the ampule 200 pg of methylergometrine or placebo.Main outcome measures Need for further oxytocic drugs, blood pressure, the presence of side effects, mean haemoglobin and haematocrit three days after delivery.Results Two hundred women completed the study (100 received methylergometrine and 100 misoprostol). Postpartum haemorrhage occurred in 4.3% of the methylergometrine group and 8.3% of the misoprostol group ( P = 0.57). The need for further oxytocic drugs was 4.4% and 12.8% after methylergometrine and misoprostol, respectively (P = 0.065). One hour after the birth of the baby there was no difference in the mean systolic blood pressure (117 k 12 mmHg versus 115 f 11 mmHg) ( P = 0.26) or the mean diastolic blood pressure (72 k 10 mmHg versus 7 1 k 11 mmHg for the groups receiving methylergometrine or misoprostol, respectively) (P = 0.97). The mean temperature in the misoprostol group rose to 37.4"C, compared with 37°C in the methylergometrine group (P c 0.0001). In the misoprostol group 34% developed fever (> 38°C) compared with 3% in the methylergometrine group ( P < O~OOOl). Shivering (visual analogue score 2 8) also occurred more often after misoprostol (42%) than after methylergometrine (8.5%) (P c 0.0001). The haemoglobin level (g/dL) on the third postpartum day was similar for both groups (1 1 . O and 11.2 for methylergometrine and misoprostol, respectively) (P = 0.39).Conclusions This study suggests that although protection from postpartum haemorrhage using parenteral methylergometrine and oral misoprostol is nearly equal, misoprostol is associated with more side effects.for the prevention of postpartum haemorrhage.

A prospective randomized controlled trial for comparison of oral misoprostol with methyl ergometrine in the third stage of labour for prevention of post-partum haemorrhage

“…There was a significant reduction in the duration of the third stage of labour in Group A than Group B. The present study findings were similar with other done by Amant et, Ng et al 8,9 In the present study significant reduction in the duration of third stage of labour was achieved inspite of minimal oral dose of misoprostol.…”

Comparison of Oral Misoprostol with Intramuscular Oxytocin in the Active Management of Third Stage of Labour

“…In addition, the time for administration of therapeutic drugs is reduced from 15 minutes to five minutes. 5,6 This practice has become a standard of obstetric care, and misoprostol has emerged as a promising treatment alternative. [7][8][9] In this study, 600 mcg oral misoprostol was compared with 10 unit IM oxytocin for AMTSL and this dose of misoprostol is recommended by WHO for AMTSL when standard oxytocin is not available.…”

Randomized comparative study of oral misoprostol with intravenous methyl ergometrine in prevention of postpartum haemorrhage in cases high risk for postpartum haemorrhage

“…Similiar study conducted by Amant et al concluded a higher requirement of oxytocics additionally in misoprostol group 12.8% v/s 4.4%, whereas studies done by Refaey et al shows 14% v/s 10%, p=0.08 and Walraven G et al showed 11% v/s12%. 7,10,12 The need for additional oxytocics were similar in both the study groups. However in none of these studies the difference was statistically not significant.…”

“…Its use in 3 rd stage of labour was first suggested by El-Refaey H. 4 Amant et al conducted the study comparing efficacy and side-effects of Injection methyl ergometrine 0.2mg intravenously with misoprostol 600 µg given orally for prevention of postpartum haemorrhage. 7 Therefore, the present study was undertaken to evaluate the efficacy of oral misoprostol in the active management of 3 rd stage of labour and compare it with injection methylergometrine used intravenously in high risk women anticipating full term vaginal delivery.…”