A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

Alwani, Madhuri; Singh, Swapnil; Thakur, Ratna; Mishra, Sunita

doi:10.5455/2320-1770.ijrcog20140909

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Change in haemoglobin level in two groups was not statistically significant. Alwani M et al (10) compared rectally administered 600 ug misoprostol after spinal anaesthesia with intramuscular oxytocin during caesarean section, found no significant difference in two groups regarding change in postpartum haemoglobin, need for blood transfusion and incidence of PPH, no significant difference in any side effects. K Aruna Kumari et al assessed the impact of pre-operative 200 μg per rectal misoprostol on blood loss during and after caesarean delivery found mean intraoperative and postpartum blood loss was lower in the study group than the control group: 374 ± 69.9 mL and 131 ± 31.8 mL versus 401 ± 79.9 and 145 ± 35.6 mL respectively and concluded that preoperative administration of 200 μg rectal misoprostol significantly reduced blood loss related to elective caesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Garag¹,

Hadi²

2018

jemds

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BACKGROUND Postpartum haemorrhage is a major cause of mortality and morbidity in pregnant women in developing countries. Caesarean section is associated with increased blood loss. Misoprostol is used as potent uterotonic agent that has been thoroughly studied in the prevention and treatment of PPH after vaginal delivery. However, role of preoperative rectal misoprostol in caesarean section for reducing blood loss is not studied much, hence this study was undertaken. MATERIALS AND METHODS This randomised controlled trial was performed between Jan 2017-July 2017 on 200 high-risk pregnant women coming to labour room of Department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubli, divided into two groups. The Group A (n= 100) received 400 μg of misoprostol. The Group B (n= 100) received 10U IM oxytocin after delivery as per hospital protocol. The primary outcome measures were amount of blood loss and change in haemoglobin level 24 hrs. after surgery. RESULTS The mean intraoperative blood loss was significantly lower in Group A (389 ± 172.56 mL) than Group B (445 ± 180.42 mL). The difference between the preoperative and postoperative haemoglobin value was also significantly lower in the misoprostol group (0.84) than the oxytocin group (1.10) with (p= 0.0300). Admissions to the neonatal intensive care unit were comparable between the two groups. CONCLUSION Preoperative administration of 400 μg rectal misoprostol significantly reduced blood loss compared to oxytocin in caesarean section without significant side effects and it can be used as an alternative to oxytocin.

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Section: Discussionmentioning

confidence: 99%

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Garag¹,

Hadi²

2018

jemds

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“…Perdarahan masih menjadi penyebab utama kematian dan morbiditas pada periode post partum terutama di negara-negara berkembang. 1,2 Organisasi Kesehatan Dunia (WHO) telah melaporkan 585.000 kematian karena kehamilan setiap tahunnya. Dua puluh lima persen kasus meninggal oleh karena perdarahan post partum dengan ketentuan kehilangan darah 500 ml selama persalinan vaginal atau 1000 ml dalam operasi seksio cesarea.…”

Section: Pendahuluanunclassified

“…Dua puluh lima persen kasus meninggal oleh karena perdarahan post partum dengan ketentuan kehilangan darah 500 ml selama persalinan vaginal atau 1000 ml dalam operasi seksio cesarea. 2 Perdarahan post partum adalah salah satu komplikasi obstetrik yang paling umum terjadi pada ibu sehabis melahirkan dan termasuk tiga penyebab utama kematian ibu di seluruh dunia. 3 Persalinan secara seksio cesarea (SC) adalah prosedur operasi mayor yang paling umum dilakukan pada perempuan di seluruh dunia dan angkanya terus meningkat baik di negara maju maupun negara berkembang.…”

Section: Pendahuluanunclassified

Efikasi Misoprostol Rektal Intraoperasi Seksio Cesarea Versus Oksitosin dalam Mengurangi Jumlah Perdarahan untuk Mencegah Perdarahan Post Partum

Milhan¹,

Soejoenoes

Prawitasari³

2019

Jurnal Kespro

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Latar Belakang : Perdarahan post partum adalah salah satu etiologi kematian ibu. Setelah operasi caesar, uterotonik dalam bentuk infus oksitosin (20-40 IU) atau misoprostol rektal (200-600 μg) diberikan untuk kontraksi uterus pasca operasi pada pasien pada risiko perdarahan post partum. Penelitian ini dibuat membandingkan kedua agen uterotonik tersebut.Tujuan : Mengetahui perbandingan penggunaan misoprostol rektal tiga tablet (600 ugr) dan penggunaan oksitosin 20 IU selama operasi seksio cesarea dalam mengurangi jumlah perdarahan untuk mencegah perdarahan post partum di fasilitas kesehatan tingkat lanjut.Metode : Penelitian ini adalah double blind randomised controlled trial. Populasi penelitian adalah pasien rawat inap ruang kebidanan dan kandungan RSUD Datu Sanggul, Rantau. Besar sampel ditentukan dengan rumus Kirkwood dan Steme sebesar 98. Secara acak peserta dibagi ke kelompok misoprostol dan oksitosin. Farmasi menyediakan obat penelitian dan plasebo dalam bentuk yang tidak dapat dikenali. Untuk kelompok misoprostol disiapkan tablet misoprostol 600 μg untuk digunakan secara rektal ditambah spuit yang sudah diisi sebelumnya larutan saline normal. Kelompok oksitosin disiapkan tablet plasebo untuk digunakan secara rektal ditambah jarum suntik dengan oksitosin 20 IU dan larutan normal saline.Hasil dan Pembahasan: Didapatkan kelompok 1 (misoprostol) dari 42 sampel, yang mengalami perdarahan kurang dari 1000 ml sebanyak 41 sampel (97,6%) dan yang perdarahan lebih dari atau sama dengan 1000 ml sebanyak 1 sampel (2,38%). Sedangkan kelompok 2 (oksitosin) dari 42 sampel yang mengalami perdarahan kurang dari 1000 ml sebanyak 36 sampel (85,7% ) dan yang perdarahan lebih dari 1000 ml sebanyak 6 sampel (14,3% )Kesimpulan: Ada perbedaan bermakna antara jumlah perdarahan kelompok misoprostol dengan jumlah perdarahan kelompok oksitosin. Karena mean rank kelompok misoprostol lebih rendah dapat disimpulkan bahwa: “Jumlah perdarahan pada penggunaan misoprostol rektal tiga tablet (600 ugr) lebih sedikit dibanding penggunaan oksitosin 20 IU selama operasi seksio cesarea”. Di antara variabel-variabel perancu, riwayat partus lama dan adanya faktor keterlambatan, berhubungan dengan jumlah perdarahan. Variabel yang dapat digunakan untuk memprediksi jumlah atau banyaknya perdarahan adalah variabel “ada terlambat/tidak”. Kata Kunci: Jumlah Perdarahan, Oksitosin, Misoprostol, Perdarahan Postpartum

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“…3,9 Among these etiology, 70% of cases are caused by uterine atony. 5,6 Prevention Prevention of PPH can be done by doing active management of the third stage of labor routinely. This protocol consists of 3 procedures; the use of uterotonic agents just after the birth of baby, controlled cord traction and uterine massage.…”

Section: Etiologymentioning

confidence: 99%

“…[3][4][5] The most common cause of PPH is uterine atony and it accounts for 70% of cases. 5,6 Uterotonic agents are routinely used in active management of third stage of labour for preventing PPH. It acts by enhancing natural uterine contraction and retraction during third stage of labour.…”

Section: Introductionmentioning

confidence: 99%

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

Carlisa¹

2018

Int J Reprod Contracept Obstet Gynecol

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Postpartum hemorrhage (PPH) is defined as blood loss of at least 500 ml or more after vaginal delivery and 1000 ml or more after abdominal delivery. It contributes up to 28% of maternal mortality worldwide and 30.3% of maternal death in Indonesia. 70% cases of PPH are caused by uterine atony. PPH can be prevented by doing routine use of uterotonic agents in active management of third stage of labour. Uterotonic agents that currently available are oxytocin, carbetocin, methylergometrine, syntometrine, misoprostol and carboprost. Carbetocin (a long-acting synthetic analogue of oxytocin) is a new drug which has stronger ability to induce uterine contraction than oxytocin. It does not induce hypertension like methylergometrine and syntometrine. Therefore, carbetocin can be considered as an alternative drug to oxytocin in women with severe preeclampsia. However, more studies are needed to assess the efficacy and safety of carbetocin for prevention of PPH in preeclamptic women. Compared to methylergometrine and syntometrine, carbetocin is more effective in reducing postpartum blood loss. Adverse effects like nausea and vomiting were lower in women treated with carbetocin. Compared to misoprostol, carbetocin is also superior in reducing blood loss. Adverse effects like shivering, fever and metallic taste were higher in women treated with misoprostol. Further studies are needed to assess the superiority between carbetocin and carboprost since there is no published literature yet regarding this topic. In conclusion, carbetocin is superior to other uterotonic agents in preventing postpartum hemorrhage with fewer adverse effects.

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A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

Cited by 9 publications

References 15 publications

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Efikasi Misoprostol Rektal Intraoperasi Seksio Cesarea Versus Oksitosin dalam Mengurangi Jumlah Perdarahan untuk Mencegah Perdarahan Post Partum

Comparison of carbetocin with other uterotonic agents in preventing postpartum hemorrhage

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