Rectal Misoprostol Research Articles

Randomized controlled trial of rectal misoprostal and intramuscular oxytocin in the prevention of PPH

Background: PPH accounts for merely 23% of maternal mortality in developing countries. Misoprostol is a uterotonic agent and is a PGE analogue commonly used in management of PPH. Oxytocin is another uterotonic agent which is now been introduced as intramuscularly effective agent to prevent PPH.This study aims to compare rectal misoprostol with intramuscular oxytocin in reducing blood loss in third stage of labor to prevent PPH. Objective of present study is to compare the clinical effect of rectal misoprostol with intramuscular oxytocin in prevention of PPH.Methods: A randomized study was conducted over duration of 3 months, at Department of OBG, BRIMS, Bidar, Karnataka, India. Patients with singleton pregnancy with the history of one previous LSCS and opting for elective LSCS were included in the study. Patients with risk pregnancy, such as pre eclampsia, cardiac disease and asthma or grand multipara were excluded from the study. Immediately after spinal anesthesia rectal misoprostol was given while oxytocin was administered after delivery of the baby. Incidence of PPH and amount of blood loss was observed and compared.Results: The difference in both the groups with regard to mean amount of blood loss, mean duration of the third stage of labor, and mean amount of fall in hemoglobin level was not statistically significant as P value was >0.05. The incidence of PPH and the need for additional oxytocic are slightly more in the misoprostol group. The incidence of shivering and pyrexia was more in the misoprostol group, but not so disturbing so as to lead to disuse of this drug.Conclusions: Oral misoprostol, though not a replacement of parenterally administered oxytocin, can be used safely in all deliveries for the prevention of postpartum hemorrhage.

The Efficacy of Misoprostol Plus Vasopressin Versus Vasopressin Alone on Surgical Outcomes Through Minimally Invasive Myomectomy: Research Protocol

To compare the effect of perivascular vasopressin with a combination of rectal misoprostol plus perivascular vasopressin on blood loss reduction during minimally invasive myomectomies, a double-blind randomized clinical trial it designed to be conducted in Shiraz, Iran in 2015. The primary outcomes of the study include; blood loss during surgery and hemoglobin (Hb) drop after surgery extracting the baseline and 6-hour post-surgery serum hemoglobin levels. The secondary outcomes of the study include; duration of operation; surgical complications; post-operative complications; hemodynamic changes during surgery, administration of other uterotonic agents; and post-operative fever.

Comparing the Effectiveness of Intravenous Oxytocin Versus Rectal Misoprostol in the Management of Third-Stage of Labour After Second-Trimester Abortion

Comparing the Effectiveness of Intravenous Oxytocin Versus Rectal Misoprostol in the Management of Third-Stage of Labour After Second-Trimester Abortion

Rectal misoprostol plus perivascular vasopressin versus tourniquet to decrease blood loss during abdominal myomectomy

The aim of this study is to compare between combined preoperative rectal misoprostol plus perivascular vasopressin and tourniquet to decrease blood loss during abdominal myomectomy. In this randomized study, 104 patients were randomly allocated to receive either combined 400 μg rectal misoprostol plus perivascular vasopressin (n = 52) or tourniquet (n = 52). The main outcome measure was the operative blood loss. Secondary outcome measures included the requirement for blood transfusion, the change in hemoglobin level after operation, and incidence of complications. Blood loss was significantly greater in the group with tourniquet (375.7 ± 292.3 mL) than in the group with rectal misoprostol plus perivascular vasopressin (254.1 ± 185.4 mL) (P = 0.03). The group with tourniquet had a significant decrease in Hb level 24 h after operation (P < 0.04). Blood transfusion rate was significantly greater in the group with tourniquet (P < 0.04). The febrile morbidity was comparable in the two groups. Rectal misoprostol plus perivascular vasopressin was found to be more effective than tourniquet for decreasing blood loss during abdominal myomectomy.

Rectal misoprostol for myomectomy: A randomised placebo-controlled study.

Uterine leiomyomas are the most common benign tumours in women. Misoprostol, which is widely used in the treatment and prevention of postpartum haemorrhage in obstetrics, may decrease intra-operative bleeding in abdominal myomectomies when haemorrhage constitutes a challenging problem. To assess the effect on intra-operative blood loss of using a single pre-operative dose of rectal misoprostol in abdominal myomectomy surgeries. In a randomised double-blind placebo-controlled trial, 50 women undergoing abdominal myomectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of pre-operative of rectal 400 μg misoprostol (n = 25) or placebo (n = 25) 1 h before the operation. The primary outcome was intra-operative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT02061657. Intra-operative blood loss was significantly lower in those women randomised to receive rectal misoprostol versus the placebo group (574 ± 194.8 mL vs 874 ± 171.5 mL). Additionally, the drop in postoperative haemoglobin was significantly less in the misoprostol group (1.7 ± 0.4 g/dL) compared with the placebo group (2.1 ± 0.5 g/dL). A single pre-operative dose of rectal misoprostol (400 μg) is a simple applicable method for reducing intra-operative blood loss and operative time in abdominal myomectomy.

Endometrial ablation in the management of abnormal uterine bleeding.

Abstract Background Abnormal uterine bleeding (AUB) is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for the problem during their reproductive years. Objective To provide current evidence-based guidelines on the techniques and technologies used in endometrial ablation (EA), a minimally invasive technique for the management of AUB of benign origin. Methods Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of both location in Canada and type of practice, as well as subspecialty expertise and general background in gynaecology. The committee reviewed all available evidence in the English medical literature, including published guidelines, and evaluated surgical and patient outcomes for the various EA techniques. Recommendations were established by consensus. Evidence Published literature was retrieved through searches of MEDLINE and The Cochrane Library in 2013 and 2014 using appropriate controlled vocabulary and key words (endometrial ablation, hysteroscopy, menorrhagia, heavy menstrual bleeding, AUB, hysterectomy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English from January 2000 to November 2014. Searches were updated on a regular basis and incorporated in the guideline to December 2014. Grey (unpublished) literature was identifies through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Results This document reviews the evidence regarding the available techniques and technologies for EA, preoperative and postoperative care, operative set-up, anaesthesia, and practical considerations for practice. Benefits, harms, and costs Implementation of the guideline recommendations will improve the provision of EA as an effective treatment of AUB. Following these recommendations would allow the surgical procedure to be performed safely and maximize success for patients. Conclusions EA is a safe and effective minimally invasive option for the treatment of AUB of benign etiology.

English

There are various methods have been described for preoperative cervical priming prior to vacuum aspiration (VA) in first trimester pregnancy termination, to facilitate cervical dilatation and shorten the abortion procedure. Recently, misoprostol has been globally the most investigated drug for medical abortion. Misoprostol is affordable, is easily stored at room temperature, and possesses a shelf life of several years. In our prospective interventional comparative study misoprostol (800µg) administered per vaginally was compared tomisoprostol (800µg) administered per rectally for first trimester termination of pregnancy and were observed for spontaneous expulsion of products of conception. The complete abortion rate was 62.86% in vaginal group in contrast to 20% in rectal group which was statically significant and majority of cases in rectal group had incomplete abortions. In vaginal group, patients with < 8 weeks gestational age aborted completely comparable to the patients with gestational age 8-12 weeks while in rectal group, patients< 8 weeks gestational age had aborted completely in contrast to the patients with gestational age 8-12 weeks which was significant statistically and hence the efficacy of rectal misoprostol was

Comparative Study of Rectal Misoprostol to Oxytocin Infusion in Preventing Postpartum Haemorrhage After Caesarean Section

Aims: This comparative study aimed to compare the efficacy of rectal misoprostol to oxytocin infusion in preventing primary postpartum haemorrhage after caesarean section. Methods: Fifty pregnant women with identifiable risk factors for post-partum haemorrhage who delivered baby by caesarean section were randomized to receive 600 μg rectal misoprostol and a placebo infusion intravenously or placebo rectally and a 20 iu oxytocin infusion. Post-operative blood loss four hours after surgery was estimated by application of pads of known weight. Results: The mean immediate four hours post-operative blood loss was not significantly different between the rectal misoprostol and oxytocin infusion group (100.08 ± 24.85 ml versus 108.20 ± 29.93 ml; p =0.144) and the change between the pre-operative and post-operative hematocrit was similar. Conclusions: Post-caesarean section rectal misoprostol has comparative efficacy to oxytocin infusion in preventing post-partum haemorrhage. It is recommended for use as alternative uterotonic in settings where there is low refrigeration capacity.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 34-37 DOI: http://dx.doi.org/10.3126/njog.v8i2.9767

Impact of Preoperative Rectal Misoprostol on Blood Loss During and After Elective Cesarean Delivery

Abstract Objective To evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective cesarean delivery. Methods A randomized controlled trial was conducted among 400 women scheduled for elective cesarean delivery. The study group (n = 200) received 400 μg of misoprostol. The control group (n = 200) received placebo. Study medications were administered rectally after catheter insertion and shortly before skin incision. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values. Results The mean intra-operative and postpartum blood loss was significantly lower in the study group than the control group: 429 ± 234 mL and 185 ± 95 mL versus 620 ± 375 mL and 324 ± 167 mL, respectively (P = 0.001 for both comparisons). The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.62 ± 2.45 versus 8.15 ± 3.84; P = 0.02). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the 2 groups. Conclusion Preoperative treatment with 400 μg rectal misoprostol significantly reduced blood loss related to elective cesarean delivery. Clinical trial registration No.: ACTRN12611000638932 .

English

BACKGROUND AND OBJECTIVES: To compare the management of third stage of labour by 400µg rectal misoprostol versus intramuscular 125 µg PGF2α and to study the side effects of the drugs. METHODS: 200 low risk women at term with spontaneous labour were studied and were randomly divided into 2 groups. Group – I were administered per rectal misoprostol 400 µg and group – II PGF2α – 125 µg respectively at delivery of anterior shoulder of foetus. Outcome with regard to duration of III stage of labour, amount of blood loss, difference in haemoglobin, need for additional oxytocics and side effects were studied. RESULTS: Significant reduction in duration of third stage (P < 0.05) and blood loss (P < 0.05) was seen in PGF2α (125 µg) group compared to misoprostol. Reduction in Hb% postpartum (after 48 hours) was also significantly less in PGF2α (125 µg) group vs.misoprostol group. Need for additional oxytocics was more in misoprostol group (10 cases) when compared to PGF2α group 17 cases. In both groups, 1 patient had retained placenta. In PGF2α gp., GI side effects like nausea (13%), vomiting (3.5), abdominal cramps (17.5%) were seen. While misoprostol group had low incidence of GI side effects; nausea (6.5%), vomiting (2%), pyrexia (18%) and shivering (24%) were seen in a higher incidence. CONCLUSION: PGF2α results in more effective reduction in duration of third stage of labour, lesser blood loss, significantly lesser reduction in Hb level after delivery and is associated with side effects like nausea, vomiting, diarrhoea and abdominal cramps while per-rectal misoprostol is less effective but with side effects like pyrexia and shivering.

A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy

To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies. Prospective, randomized, double-blind, controlled study. University of the West Indies and Andrews Memorial Hospital. Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy. Abdominal myomectomies on patients with symptomatic uterine fibroids. Perioperative blood loss and febrile morbidity. There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids. We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone. NCT01700478.

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. Systematic review and metaanalysis of randomized controlled trials. Seventeen studies (3174 women) were included of which 7 evaluated misoprostol vs oxytocin and 8 evaluated misoprostol plus oxytocin vs oxytocin alone. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, -2.1%; 95% confidence interval, -3.4 to -0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% confidence interval, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during cesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.

Efficacy of rectal misoprostol for prevention of postpartum hemorrhage.

Postpartum hemorrhage is an important cause of maternal morbidity and mortality after delivery. Active management of postpartum hemorrhage by an uterotonic drug decreases the rate of postpartum hemorrhage. The aim of this study is to evaluate the efficacy of rectal misoprostol for prevention of postpartum hemorrhage. This double blind randomized clinical trial was performed on full term pregnant women candidate for vaginal delivery, referred to Zahedan Imam Ali Hospital during 2008-2009. They were randomly divided into two groups of rectal misoprostol and oxytocin. The women in misoprostol group received 400 μg rectal misoprostol after delivery and the women in oxytocin group received 3 IU oxytocin in 1 L ringer serum, intravenously. Rate of bleeding, need to any surgery interventions, rate of transfusion and changes in hemoglobin and hematocrite were compared between two groups. A total of 400 patients (200 cases in misoprostol group and 200 in oxytocin group) entered to the study. Rate of bleeding > 500 cc was significantly higher in oxytocin group than misoprostol group (33% vs. 19%) (p = 0.005). Also, need to excessive oxytocin for management of postpartum hemorrhage was significantly lower in misoprostol group than oxytocin group (18% vs. 30%) (p = 0.003). Decrease in hematocrite was significantly more observed in oxytocin group than misoprostol group (mean decrease of hematocrite was 1.3 ± 1.6 in misoprostol group and 1.6 ± 2.2 in oxytocin group). Two groups were similar in terms of side-effects. Rectal misoprostol as an uterotonic drug can decrease postpartum hemorrhage and also can prevent from decrease of hemoglobin as compared to oxytocin.

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

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.

W371 COMPARATIVE STUDY OF RECTAL MISOPROSTOL TO OXYTOCIN INFUSION IN PREVENTING POSTPARTUM HAEMORRHAGE POST-CAESAREAN SECTION

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S825-S825 Poster presentations W371 COMPARATIVE STUDY OF RECTAL MISOPROSTOL TO OXYTOCIN INFUSION IN PREVENTING POSTPARTUM HAEMORRHAGE POST-CAESAREAN SECTION A.I. Adanikin, A.I. AdanikinSearch for more papers by this authorE.O. Orji, E.O. OrjiSearch for more papers by this authorP.O. Adanikin, P.O. AdanikinSearch for more papers by this authorO. Olaniyan, O. OlaniyanSearch for more papers by this author A.I. Adanikin, A.I. AdanikinSearch for more papers by this authorE.O. Orji, E.O. OrjiSearch for more papers by this authorP.O. Adanikin, P.O. AdanikinSearch for more papers by this authorO. Olaniyan, O. OlaniyanSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)62094-3Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S825-S825 RelatedInformation

The effect of post-cesarean rectal misoprostol on intestinal motility

ObjectiveTo determine whether rectally administered misoprostol can induce intestinal motility compared with oxytocin infusion when used to prevent primary postpartum hemorrhage after cesarean delivery. MethodsIn a prospective randomized double-blind study in Nigeria, 218 parturients undergoing cesarean delivery who had risk factors for primary postpartum hemorrhage were enrolled between July 1, 2010, and March 31, 2011. Participants received 600μg of rectal misoprostol or 20 intravenous units of oxytocin for 4hours after surgery. The primary outcome was time until passage of flatus. Adverse effects, need for additional analgesic, and length of hospital stay were also assessed. ResultsThe misoprostol group had a significantly shorter mean postoperative interval to passage of flatus (20.27±7.77hours versus 38.34±10.98hours; P<0.001) and commencement of regular diet (21.08±7.69hours versus 39.13±10.94hours; P<0.001). Gastrointestinal adverse effects were more frequent, albeit not significantly, in the misoprostol group: nausea, 6.4% versus 1.8%; vomiting, 7.3% versus 2.8%; and abdominal distension, 3.7% versus 2.8%. The need for additional analgesic was the same in the 2 groups. ConclusionAfter cesarean delivery, rectal misoprostol had the added benefit of inducing intestinal motility. Misoprostol might be considered in a clinical setting where postoperative ileus is anticipated.

Active management of third stage of labor by intravenous ergometrine and rectal versus sublingual misoprostol (a double-center study)

BackgroundActive management of third stage of labor is a feasible and inexpensive intervention that helps saving thousands of women's lives. ObjectiveThe aim of the study was to compare the efficacy of IV ergometrine, rectal versus sublingual misoprostol in active management of third stage of labor. The same protocol was applied to Al-Jomhoria Hospital, Garunis University, Benghazi, Libya. MethodsThe study was conducted on 300 primigravida (150 Alexandria University El-Shatby Maternity Hospital, 150 in Al-Jomhoriya Hospital, Benghazi University) who underwent normal vaginal delivery and were divided into 3 groups according to the drug used in management of third stage of labor (ergometrine IV, one rectal tablet of misoprostol, one sublingual tablet of misopristol) All patients were closely observed for time of placental delivery, amount of blood loss by Hb and hematocrit value pre and immediately post delivery (within 1h), use of oxytocin and any recorded side effects. ResultsDuring the follow up of Alexandria & Jamhoriya cases, it was found: 200mcg sublingual misopristol was more effective than 200mcg rectal misopristol and IV ergometrine immediately after delivery, as it decreased the amount of blood loss [mean estimated blood loss in IV ergometrine group was 331.2ml/320.33, rectal misopristol group was 310.7/305.9, sublingual misopristol group was 227.6/270.01, respectively. P1=0.001∗, P2=0.001∗/P1=0.036∗, P2=0.045∗]. The most common side effects occurred in sublingual misopristol group 8% had fever, 30% had shivering in Alexandria group and 98% had shivering in Jamhoriya group. ConclusionMisoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage. Sublingual misopristol is a more effective uterotonic drug in management of third stage of normal labor than IV ergometrine and rectal misoprostol.

Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery

ObjectiveTo evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective cesarean delivery. MethodsA randomized controlled trial was conducted among 400 women scheduled for elective cesarean delivery. The study group (n=200) received 400μg of misoprostol. The control group (n=200) received placebo. Study medications were administered rectally after catheter insertion and shortly before skin incision. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24hours, and difference between preoperative and postoperative hematocrit values. ResultsThe mean intra-operative and postpartum blood loss was significantly lower in the study group than the control group: 429±234mL and 185±95mL versus 620±375mL and 324±167mL, respectively (P=0.001 for both comparisons). The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.62±2.45 versus 8.15±3.84; P=0.02). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5minutes were comparable between the 2 groups. ConclusionPreoperative treatment with 400μg rectal misoprostol significantly reduced blood loss related to elective cesarean delivery.Clinical trial registration No.:ACTRN12611000638932.

Rectal Misoprostol versus Intramuscular Oxytocin for Prevention of Post Partum Hemorrhage

Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries.,Compared to expectant management, active management decreases the incidence of PPH. To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the prevention of postpartum hemorrhage. This is a prospective, randomized and analytical study from 1 st September 2009 to 28th February 2010 at Department of Obstetrics and Gynecology, Dhulkhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal. A total of 200 women were included to receive either 1000 micrograms rectal misoprostol tablets or 10 units of oxytocin intramuscularly. Primary outcome measures were the incidence of postpartum hemorrhage or a change in hematocrit or hemoglobin from admission to day two post delivery. Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were noted. Also the side effects of both misoprostol and oxytocin were recorded. The frequency of postpartum hemorrhage was 4% in the misoprostol subjects and 6% in the control subjects (P=0.886) There were no significant difference among the groups in the drop of hematocrit (P>0.05). Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were similar in both groups. Similarly, the side effects between the misoprostol and oxytocin group within 6 hours was statistically significant (p=0.003) whereas the side effects within 24 hours was statistically not significant (p=0.106). Rectal misoprostol is as effective as intravenous oxytocin in preventing postpartum hemorrhage with the similar incidence of side effects and is worthwhile to be used as a uterotonic agent for the routine management of third stage of labor.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of postpartum hemorrhage in women at risk: A randomized controlled trial

The aim of this study was to evaluate the efficacy of adjunctive rectal misoprostol compared to oxytocin infusion in the prevention of primary postpartum hemorrhage after routine active management of the third stage of labor in women with identifiable risk factors for uterine atony. A double-blind randomized controlled trial was carried out at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 264 parturients with known risk factors for postpartum hemorrhage were randomized to receive either rectal misoprostol (600 µg; n = 132) or oxytocin infusion (20 IU in 500 mL; n = 132) after routine active management of the third stage of labor. Intrapartum blood loss was measured using a combination of the BRASSS-V calibrated drapes and differential pad weighing. Hematocrit was measured intrapartum and 24 h postpartum. There was no significant difference (P = 0.07) in the mean intrapartum blood loss between the misoprostol (387.28 ± 203.09 mL) and oxytocin (386.73 ± 298.51 mL) groups. There was also no difference in the requirement for additional intervention for uterine atony (P = 0.74). Postpartum hematocrit drop and blood transfusion were, however, significantly less in the misoprostol group. Rectal misoprostol is as effective as oxytocin infusion as an adjunct for prevention of postpartum hemorrhage in women with risk factors for uterine atony and is associated with a lower hematocrit drop and blood transfusion postpartum. However, shivering, pyrexia and vomiting are more frequent with misoprostol, though usually self-limited.