This present prospective study “Comparative study of efficacy of
rectal misoprostol versus intravenous methylergometrine in the prevention
of PPH in at risk PPH mothers” was carried out at Govt. Kasturba Gandhi
Hospital Madras Medical College, Chennai during the period October 2004
– August 2005.
Total of hundred cases who had any of the risk factors for PPH
were included in the study.
Group I - Included fifty patients in whom intravenous methyl ergometrine was
administered following delivery of anterior shoulder.
Group II - Included fifty patients in whom, 800 mcg of misoprostol was kept
rectally following delivery of the anterior shoulders.
The efficacy of prophylactic intravenous methyl ergometrine, and
rectal misroprostal in reducing the postpartum blood loss were compared
in terms of duration of third stage, amount of blood loss, need for
additional oxytocic therapy and change in prenatal and postnatal
hemoglobin level in gm % and the results were statistically analyzed.
Observations of this study includes,
• Most of the patients were in the age group of 20-30 years.
• 99% of cases were booked and most of the patients were belonged
to class V socio-economic status.
• 42% of cases were second gravida 33% of cases were primigravida
and 3 case were grand multipara.
• 54% of cases had overdistended uterus and 37% of cases had
prolonged labor as the risk factor for PPH.
• 70% of cases had spontaneous onset of labor and in remaining
30% of cases labor was induced with either ARM & oxytocin, PGE2
gel alone or PGE2 with oxytocin.
• 47% of patients were delivered by labor natural with episiotomy or
perineal laceration of IIo. 11% of cases had operative vaginal
delivery either vacuum extraction or forceps delivery in whom
traumatic PPH had been ruled out.
• The duration of third stage in 90% of cases in control group was
less than 4minutes , and only in 50% of cases in study group it
was less than 4 minutes .
• The difference in the mean duration of third stage of labor between
the two group was 1.25 minutes .
• 56% of cases in control group had blood loss of lessthan 200ml.
Only 12% of cases in study group had blood loss of lessthan200ml.
70% of cases in study group had blood loss of 200 - 400ml.
• Prolonged labor is associated with significantly increased blood
loss, when compared to other risk factors.
• The difference in mean blood loss between the two groups was
74ml. Comparing the absolute blood loss, parenteral methyl
ergometrine appears to be more effective than rectal misoprostol
in reducing postpartum blood loss.
• Incidence of PPH was 8% in study group as compared to only 4%
in control group.
• 12% cases in study and 4% cases in control group required
additional parenteral oxytocic drugs.
• The major side effects noted in study group were pyrexia (14%)
and shivering (20%)
• Common side effect noted in control group was increase in blood
pressure. (16%)
• Hemoglobin difference of less than 1gm% was noted in 92% of
cases in control group and 84% of cases in study group.
• Mean hemoglobin difference between control and study group was
0.31gm%, which has no statistical significance.
CONCLUSION:
Active management of third stage of labor should be the
routine management of choice for women expecting to
deliver a baby by vaginal route in a maternity hospital.
• Rectal misoprostol is less effective than intravenous methyl
ergometrine as part of the active management of third stage
of labor for prevention of postpartum hemorrhage .
• Misoprostol need not replace oxytocin or ergometrine for
prophylaxis in hospitals where these drugs could be properly
stored.
• Misoprostol is a very valuable drug in the armamentarium of
doctors in rural setting and especially midwives, who work in
the periphery in developing countries, where these
parenteral drugs could not be stored at the desired
temperature and where parenteral drugs are impractical to
administer or simply not available.
• In above situations, misoprostol which is inexpensive, thermo
stable with good safety profile will have clear advantages
over other conventional injectable oxytocics like methyl
ergometrine .
• This drug can be safely administered even by paramedical
personnel while referring a mother with PPH to higher
institutions.
• So, misoprostol deserves a special place in every pharmacy,
health post and midwifery list and has considerable potential
to reduce the maternal mortality from postpartum
hemorrhage in developing countries.
So, in countries with high maternal mortality and limited resources,
introducing low cost, evidence based practices that prevent PPH is an
important way to improve women’s health