Misoprostol and active management of the third stage of labor

Prata, Ndola; Hamza, Sarah A.; Gypson, R.; Nada, Khaled M.; Vahidnia, Farnaz; Potts, Malcolm

doi:10.1016/j.ijgo.2006.05.027

Cited by 28 publications

(30 citation statements)

References 21 publications

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“…In addition, approximately 5% of women bled ≥350 ml in secondary prevention clusters, which is lower than the 25% hypothesised based on prior studies 13. The reasons for the low levels of bleeding in this study are unclear, although other studies document low or declining measured ‘PPH rates’ during study recruitment, thought to be due to increased provider confidence and training 21, 22, 23, 24, 25. In compliance with government policy, ANMs referred high‐risk deliveries to higher‐level facilities, and women enrolled may have constituted a low‐risk population, although numerous studies have shown that it is difficult to identify the majority of women who will experience PPH based on pre‐existing risk factors.…”

Section: Discussioncontrasting

confidence: 51%

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Raghavan

Geller

Miller

et al. 2015

BJOG

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ObjectiveTo assess whether secondary prevention, which preemptively treats women with above‐average postpartum bleeding, is non‐inferior to universal prophylaxis.DesignA cluster‐randomised non‐inferiority community trial.SettingHealth sub‐centres and home deliveries in the Bijapur district of Karnataka, India.PopulationWomen with low‐risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub‐centre and who consented to be part of the study.MethodsAuxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour.Main outcome measuresPostpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher‐level facilities, acceptability and feasibility of the intervention.ResultsMisoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference −2.9%, one‐sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013).ConclusionSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level.Tweetable abstractSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis.

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Section: Discussioncontrasting

confidence: 51%

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Raghavan

Geller

Miller

et al. 2015

BJOG

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“…The mean duration of 3rd stage of labour was also comparable in all the three groups, p = 0.115 (4.42 min oral misoprostol group, 4.420 min rectal misoprostol group, 4.158 min in IM 15methyl-PGF2α group). This was comparable to Nellore V et al study and other studies [23][24][25][26] .…”

Section: Duration Of 3 Rd State Of Laboursupporting

confidence: 91%

Role of oral misoprostol, rectal misoprostol and intramuscular 15-methyl-PGF2α for prophylaxis of postpartum haemorrhage

Pandey

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPostpartum haemorrhage is the most common cause of maternal mortality and accounts for one quarter of maternal deaths worldwide. Approximately 28% of maternal deaths worldwide are due to haemorrhage, mostly in the postpartum period. Most maternal deaths due to PPH occur in developing countries in settings where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent PPH and shock. To improve the maternal mortality ratio further from ~174 per 100,000 live births in 2015, we have to put focussed attention to confronting the problem of PPH in India. 1,2 Despite safe motherhood activities since 1987, women are still dying in childbirth. Women living in low resource settings are most vulnerable due to concurrent disease, poverty, discrimination and limited access to health care. Indeed 99% of maternal deaths occur in developing countries that have an inadequate transport system, limited access to skilled caregivers and ABSTRACT Background: Postpartum haemorrhage (PPH) is the most common cause of maternal mortality. Approximately 28% of maternal deaths worldwide are due to haemorrhage, mostly in the postpartum period. The WHO estimates that of the 303,000 maternal deaths occurring every year, 45,000 takes place in India, where two third of maternal deaths occur after delivery, PPH being the most common cause of death (29.6%). This study compared oral misoprostol, rectal misoprostol and intramuscular 15methyl-PGF2α for prophylaxis of postpartum haemorrhage in terms of various outcomes such as drop in Hb concentration after delivery, the amount of blood loss during delivery and duration of third stage of labour. Methods: Randomized comparative trial in 1:1:1 ratio of oral misoprostol, rectal misoprostol and IM 15methyl-PGF2α groups of 300 low risk pregnant women (with singleton pregnancy and ≥28 weeks gestation age) who underwent normal vaginal delivery at Kasturba hospital during 1 year period. Results: The mean blood loss was significantly less in IM 15methyl-PGF2α group as compared to oral and rectal misoprostol groups. Incidence of PPH was least in IM 15methyl-PGF2α group as compared to oral and rectal misoprostol groups but the difference observed was not statistically significant. Maximum cases with Hb drop > 1 gm/dl were present in the rectal misoprostol group. Conclusions: IM 15methyl-PGF2α was found to be most effective and rectal misoprostol was found to be least effective for prophylaxis of PPH. Gastrointestinal side effects like nausea, vomiting and diarrhoea were significantly higher in the IM 15methyl-PGF2α group, however it had much lower incidence of shivering and pyrexia.

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“…The present study revealed the superiority of rectal misoprostol regimen over intravenous oxytocin. Previously, other studies had shown similar results for oral misoprostol (15). Contrary to our findings, some studies have reported that the percentage of retained placenta and the amount of bleeding in the intervention group of oxytocin were significantly lower in the intramuscular oxytocin group (10).…”

Section: Discussioncontrasting

confidence: 52%

Comparing the Effectiveness of Intravenous Oxytocin Versus Rectal Misoprostol in the Management of Third-Stage of Labour After Second-Trimester Abortion

Mobaraki¹,

Kahnamouei-aghdam²,

Amani³

2016

IJWHR

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IntroductionVarious reasons can lead to abortion in the second trimester of pregnancy. Abortion in the second trimester of pregnancy causes significantly more complications like hemorrhage and placental retention as compared to the abortions occurring in gestational ages less than 8 weeks. In order to control and improve the third stage of labor, several medications derived from oxytocin, ergots, and prostaglandin groups can be used orally, vaginally, and rectally (1-5). Rectal, vaginal and oral misoprostol can be used for controlling hemorrhage in the third stage of delivery. Rectal administration of misoprostol has the advantage of having high level of absorption in the body and fewer complications in comparison to its oral form. Cases of retained placenta in different studies have been reported between 8%-80% (6,7). The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol in the management of the third stage of labor during pregnancy termination. Materials and MethodsIn this randomized clinical trial, 100 women with gestational age of 14-28 weeks, visiting for terminating the pregnancy due to intrauterine fetal death (IUFD) or approved premature rupture of membrane (PROM), entered the study. After being informed about the possible abortion procedures, medications, side effects and methods of implementation, they completed the consent form and were divided into two groups of 50 patients each by random selection methods (by selecting one of the red and blue cards). All women in the two groups (oxytocin and misoprostol) underwent the same protocol of receiving 200 µg vaginal misoprostol every 6 hours. In case of having cesarean, lower doses of misoprostol were administered, which lasted for 24 hours, and if no response was received, it would be continued for the next 24 hours. After 48 hours, while considering the condition of the cervix and its dilation, other methods such as putting catheter into the cervix or using high doses of oxytocin would be used. After recording the time of fetal expulsion, intravenous oxytocin including 40 units of oxytocin in a liter of normal saline during one hour was administered to one group and 400 µg of rectal misoprostol was administered to the other group. We had 1 hour to register the time of placenta expulsion and during this time the patients were monitored every 15 minutes and their vital signs including blood pressure, heart rate and the amount of bleeding based on the number of consumed pads, fever, chills, diarrhea and vomiting were checked and recorded. If placental expulsion did not occur in an hour or the vital signs of mother were unstable, or vaginal bleeding was severe, the patients would undergo curettage and the uterine contents would be removed and sent to pathology. In case AbstractObjectives: To compare the efficacy of intravenous oxytocin versus rectal misoprostol in the management of the third stage of labor during pregnancy termination. Materials and Methods: In this randomized clinical trial, 100 pregnant women i...

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Misoprostol and active management of the third stage of labor

Abstract: In situations where oxytocin and or ergometrine are not consistently and appropriately used during third stage of labor, misoprostol should be considered for inclusion in the AMTSL protocol.

Cited by 28 publications

References 21 publications

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster‐randomised non‐inferiority community trial

Role of oral misoprostol, rectal misoprostol and intramuscular 15-methyl-PGF2α for prophylaxis of postpartum haemorrhage

Comparing the Effectiveness of Intravenous Oxytocin Versus Rectal Misoprostol in the Management of Third-Stage of Labour After Second-Trimester Abortion

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