Prevention of post-partum hemorrhage by rectal Misoprostol: A randomized clinical trial

Abstract

Background:Post-partum hemorrhage (PPH) is a common cause of maternal mortality in developing countries. This trial was conducted to study the effectiveness and safety of rectal misoprostol for PPH.Aim:To assess the effectiveness and safety of misoprostol and comparing with oxytocin for prevention of PPH.Materials and Methods:Women were randomized to receive either two 200 μg rectal misoprostol tablets (study group) or 20 units oxytocin in 1000 cc normal saline intravenously (control group). The outcomes were incidence of PPH, amount of blood loss, duration of labor, incidence of side effects, pre- and post-delivery hemoglobin, and use of additional uterotonics.Finding:The incidence of PPH was 12% in the study group and 10% in the control group (P > 0.05). No significant difference was observed between the groups hematocrit (P > 0.05). Other variables including severe PPH and duration of the third stage of labor were similar in both groups.Conclusion:Rectal misoprostol was as effective as intravenous oxytocin for preventing post-partum hemorrhage with the same incidence of side effects and is recommended to be use as an uterotonic agent to manage third stage of labor routinely.

A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients

“…The recorded higher incidence of shivering and pyrexia in this study among the misoprostol group is in keeping with previous studies on the use of misoprostol for prevention and treatment of PPH 17,19,20,21,22. Shivering and pyrexia from misoprostol are expected due to prostaglandin E effects on central thermoregulation centre 16…”

Tecnologias de cuidado para prevenção e controle da hemorragia no terceiro estágio do parto: revisão sistemática

“…Birth spacing influences this result; that is, greater blood loss in found among childbirths with intervals of less than two years 36 . Other studies 21,25-26,28,30 did not report significant differences in regard to this aspect.…”

“…The use of misoprostol was analyzed in studies with different compositions and administration routes to prevent PPH 21-26,29,31-32,37,41 . These studies show that, regardless of the dosage of misoprostol, the duration of the third stage of the labor did not present significant differences, nor did the drop in the concentration of hematocrit/hemoglobin, except in those papers 24,32 that found a decrease in the concentration of these hematological components.…”

“…Studies report that both that the duration of the third period of labor and mean loss of blood were significantly longer and greater 23,29,42-43 and shorter and lower 22,24,32,34,37,41 .The occurrence of PPH and/or severe PPH was greater among women who received misoprostol 22,43-44 . The RCTs 21,26,32,36,46 report that misoprostol was more efficacious in preventing PPH among women with inadequate birth spacing, that is, less than two years. This drug/dosage/route was effective when used in the treatment of primary PPH caused by uterine atony 59 .…”

“…Side effects were common in all women who received misoprostol. Most studies comparing oxytocin to misoprostol report significant differences in which groups treated with misoprostol experienced more side effects, especially tremors and fever 21-26,29,31,34,37-38,42,44-45,47-50 , with the exception of one study 32 that did not report significant differences. Other symptoms like nausea, vomiting and diarrhea were found, but no significant differences were found between groups 21-26,29,31,38,43,50 .…”