A randomised controlled trial of oral misoprostol vs injection methylergometrine for prevention of post partum hemorrhage

Authors

  • Neelamma B. Patil Department of Obstetrics & Gynaecology, BLDE University’s Shri. B. M. Patil Medical College & Research Centre, Bijapur, Karnataka, India
  • Shobhana S. Patted Department of Obstetrics & Gynaecology, KLE University’s Javaharlal Nehru, Medical College & Research Centre, Belgaum, Karnataka, India

Keywords:

Postpartum hemorrhage, Misoprostol, Methylergometrine, Active management of third stage

Abstract

Background: To compare the efficacy of 600mcg of oral misoprostol with 0.2mg of injection methylergometrine for the prevention of post partum hemorrhage.

Methods: 200 apparently normal pregnant women were randomized to receive either 600mcg of oral misoprostol (study group) after delivery of baby or 0.2 mg of methylergometrine intravenously (control group) after delivery of placenta. Primary outcome was to know the incidence of post partum hemorrhage in both the groups. Secondary outcome measures were to look for mean blood loss, need for any other uterotonic agents, need for blood transfusion, need for surgical intervention, mean duration of third stage and side effects of both the drugs.

Results: Out of 200 cases, two cases were excluded for the final analysis. Incidence of PPH was 9% in misoprostol group & 6% in methylergometrine group which was not significant (p >0.05). There were no significant differences among both the groups in mean blood loss, duration of bleeding, need for further oxytocics and duration of third stage. Shivering was significantly more common in misoprostol group (36% Vs 2% p< 0.0027).

Conclusion: Efficacy of 600mcg of oral misoprostol is comparable to injection methylergometrine 0.2 mg intravenously for prevention of post partum hemorrhage. So, in settings where methylergometrine is used routinely for prophylaxis, oral misoprostol can be used with more ease & other advantages over injectables. Significantly more number of patients in misoprostol will have shivering as a major side effect, which should be kept in mind.

References

Maternal mortality- Media centre” Fact sheet N°348;May 2012, http://www.who.int/mediacentre/ factsheets/fs348/en/index.html.

Park K. Preventive and Social Medicine. 21st ed. Chapter no.9. Jabalpur: M/S. Banarsidas Bhanot Publishers; 2005:383-437.

McCormick M.L., Sanghvi H.C.G., Kinize B., McIntosh N. Preventing post partum hemorrhage in low resource settings. International journal of Gynecology and Obstetrics India 2002; 7(5):52-60.

Hazem E R, Nooh Randa, Pat O’ Brien, Mona Abdalla, Michael G., Jane Wadler, Charles R. The misoprostol third stage of labour study: a randomized controlled comparison between orally administered misoprostol and standard management. BJOG September 2000; 107:1104-1110.

Godman, Gilman. The pharmacological basis of therapeutics. 10th ed, Chapter No.37. USA : McGraw-Hill; 2001 : 1005-1020.

Caliskan Eray, Meydanli Mutlu M. Dilbaz Berna, Ayakan Burcu, Sonmezer Meral, HAberal Ali. Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial. Am J Obstet Gynecol 2002;187: 1038-45.

James D.K. Steer P.J. Weiner C.P. Gonik B. High risk pregnancy management options. 2nd ed. Chapter 69. W.B. Sounders 2003; 1231-1246.

Cynthia Stanton, Deborah Armbruster, Rod Knight, Iwan Ariawan, Sourou Gbangbade, Ashebir Getachew et al. Use of active management of the third stage of labour in seven developing countries. Bulletin of the World Health Organization 2009;87:207-215.

Aman Bhullar, Carlan SJ, Hamm Jennifer, Lambety Norman, White Leigh, Richichi Kris. Buccal misoprostol to decrease blood loss after vaginal delivery: A randomized trail. Obstet Gynaecol 2004;104(6): 1282-1288.

G Justus Hofmeyr, A Metin Gülmezoglu, Natalia Novikova, Verena Linder, Sandra Ferreira, Gilda Piaggio. Misoprostol to prevent and treat postpartum hemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bulletin of the World Health Organization 2009; 87:666-677.

Hazem El-Rafaey, Pat O’ Brien, Wale Morafa, Jane Walder, Charles Rodeck. Misoprostol for third of stage of labor. Lancet 1996:347:1257.

Hazem El- Refaey, Pat O’Brien, Wale Morafa, Jane Walder, Charles Rodeck. Use of oral misoprostol in the prevention of postpartum haemorrage. British Journal of Obstetrics & Gynaecol 1997; 104: 336-339.

Amant Frederic, Spitz Bernard, Timmerman Dirk, Corremans Annick, Assche Van Andre frans. Misoprostol compared with methylergometrine for the prevention of postpartum hemorrhage: a double-blind randomized trial. British Journal of Obstet & Gynecol 1999; 106: 1066-1070.

Gulmezoglu AM, Villar J. Ngoc, Piaggio G, Carroli G, Adetoro L, Abdel-Aleem H et al. WHO multicenter randomized trial of misoprostol in the management of third stage of labor. Lancet 2001; 358:689-695.

Walraven G, Blum J, Dampha Y, Sowe M, Morison L. et al. Misoprostol in the management of third stage of labor in home delivery setting in rural Gambia: a randomized controlled trial. Br J Obstet & Gynaecol 2005;112:1-7.

Surbek Daniel V., Fehr Peter M., Hosle Irene., Holzgreve Wolfgang. Oral misoprostol for the third stage of labor: A randomized placebo-controlled trial. Obstet & Gynecol 1999; 94:255-258.

Walley Robert L, Wilson John B, Crane JMG, Mathews Kay, Sawyer Elizabeth, Hutcheas Donna. A double-blind placebo controlled randomized trial of misoprostol and oxytocin in the management of third stage of labor. British Journal of Obstet & Gynecol 2000;107:1111-1115.

Lumbiganon Pisake, Hofmeyr J, Gulmezoglu AM, Pinol A, Villra J. Misoprostol dose-related shivering and pyrexia in the third stage of labor. British Journal of Obstet & Gynecol 1999;106:304-308.

Gary C F, Kenneth J.L, Steven L.B, John C.H, Larry C., Kathetrine D.W. Williams Obstetrics. 23nd ed. Chapter no. 35. USA: Macgraw Hill publication; 2005:809-854.

Darney PD. Misoprostol: a boon to safe motherhood… or not? Lancet 2001;358:682-683.

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Published

2016-12-10

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Original Research Articles