Abstract
Objectives: To determine the feasibility of measuring intra-uterine pressure prior to placental delivery, using a novel minimally invasive method. Design: A prospective exploratory physiological study. Methods: Thirty-six low risk women undergoing normal vaginal delivery were randomly allocated to four groups. Group A received 600 mcg rectal misoprostol; group B received 600 mcg oral misoprostol; group C received 10 international units oxytocin intramuscularly after delivery of the anterior shoulder; group D received intramuscular oxytocin, 30 minutes after delivery of the baby. A calibrated catheter-tip intrauterine pressure transducer was used to measure the intrauterine pressure. This was introduced into the placenta via the umbilical vein, and recorded on a standard tocograph. Results: It was technically easy to introduce the catheter through the umbilical vessels in all mothers. On assessment of the tocograms, it was possible to interpret 95 out of 108 recordings (88%). Conclusions: This study demonstrated the simplicity of a novel, minimally invasive method of measuring the duration and frequency of postpartum uterine contractions prior to delivery of the placenta.
Highlights
Excessive maternal blood loss after childbirth is a leading cause of morbidity and mortality, in births without skilled attendance and where injectable uterotonics are not readily available
We looked into the possibility of measuring uterine activity with various commonly used uterotonics viz: early and late oxytocin administration, and orally and rectally administered misoprostol
The placenta was delivered before the 30 minutes of recording time in the delayed oxytocin group, and one in the early oxytocin group
Summary
Excessive maternal blood loss after childbirth is a leading cause of morbidity and mortality, in births without skilled attendance and where injectable uterotonics are not readily available. Apart from clinical trials, there is a need to describe the physiological effectiveness of uterine contractions, especially when new uterotonic agents are being investigated. The method used to date for in vivo measurements has been direct placement of a transducer into the uterine cavity [1]. This is an invasive procedure with the possibility of introducing infection from the lower genital tract into the uterus. Previous physiological study found some correlation between blood loss and uterine activity in women given intravenous oxytocin, intramuscular oxytocin-ergometrine, or oral misoprostol. Intrauterine pressure was measured with a pressure catheter inserted into the uterine cavity after delivery of the placenta [1,2]
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