Abstract
Purpose
In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage.
Methods
This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted.
Results
The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group.
Conclusions
Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.
Similar content being viewed by others
References
The World Health Report 2005—make every mother and child count [Internet]. http://www.who.int/whr/2005/en/. Accessed 3 Sep 2014
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066–1074
American College of Obstetricians and Gynecologists (2006) ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 108(4):1039–1047
India SRS Special Bulletin on Maternal Mortality 2010–12 [Internet]. http://ghdx.healthdata.org/record/india-srs-special-bulletin-maternal-mortality-2010-2012. Accessed 1 Sep 2014
Bellad MB, Tara D, Ganachari MS, Mallapur MD, Goudar SS, Kodkany BS et al (2012) Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double-blind randomised controlled trial. BJOG 119(8):975–986
Elati A, Elmahaishi MS, Elmahaishi MO, Elsraiti OA, Weeks AD (2011) The effect of misoprostol on postpartum contractions: a randomised comparison of three sublingual doses. BJOG 118(4):466–473
Bohlmann Michael K, Rath Werner (2014) Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines. Arch Gynecol Obstet 289:555–567
Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC (2002) Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod 17(2):332–336
Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ (2004) Prostaglandins for prevention of postpartum haemorrhage. Cochrane Database Syst Rev 1:CD000494
Alfirevic Z, Blum J, Walraven G, Weeks A, Winikoff B (2007) Prevention of postpartum hemorrhage with misoprostol. Int J Gynecol Obstet 1(99):S198–S201
Chaudhuri P, Biswas J, Mandal A (2012) Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women. Int J Gynaecol Obstet 116(2):138–142
Mobeen N, Durocher J, Zuberi N, Jahan N, Blum J, Wasim S et al (2011) Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial. BJOG 118(3):353–361
El-Refaey H, O’Brien P, Walder J, Rodeck C (2000) The misoprostol third stage of labour study: a randomized controlled comparison between orally administered misoprostol and standard management. BJOG 107:1104–1110
Tixier Hervé, Boucard Carole, Ferdynus Cyril, Douvier Serge, Sagot Paul (2011) Interest of using an underbuttocks drape with collection pouch for early diagnosis of postpartum hemorrhage. Arch Gynecol Obstet 283:25–29
Conflict of interest
Authors do not report any conflicts of interest.
Ethical standard
This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
All women gave their informed consent prior to their inclusion in the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Priya, G.P., Veena, P., Chaturvedula, L. et al. A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage. Arch Gynecol Obstet 292, 1231–1237 (2015). https://doi.org/10.1007/s00404-015-3763-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3763-5