The outcomes of midline versus medio-lateral episiotomy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.</p> <p>Methods</p> <p>A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants.</p> <p>Results</p> <p>Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol</p> <p>Conclusion</p> <p>A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH.</p> <p>Trial Registration</p> <p>Clinical trials.gov, Registry No. NCT00116480</p

Maternal and fetal mortality and complication s associated with cesarean section deliveries in teaching hospitals

AIM: To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals METHODS: Hospital based prospective study at 12 centers of 9 countries. RESULTS: 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section. CONCLUSION: Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.Virasakdi Chongsuvivatwong... Tran Son Thach... et al