Misoprostol for third stage of labour

El-Refaey, Hazem; O’Brien, Pat; Morafa, W.; Walder, Jane; Rodeck, Charles H.

doi:10.1016/s0140-6736(96)90771-0

Cited by 67 publications

(48 citation statements)

References 3 publications

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“…There was no significant difference in the pre-delivery and the post-delivery hemoglobin concentration amongst the four groups with P = 0.061. E1Rafaey et al [9] also reported no significant differences between misoprostol and oxytocin when comparing the drop in haemoglobin concentration. This can be explained by hemodilution that occurs during pregnancy so as to compensate for the loss during pregnancy.…”

Section: Resultsmentioning

confidence: 96%

A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine and Ergometrine–Oxytocin in Reducing Blood Loss in Active Management of 3rd Stage of Labor

Gohil

Tripathi

2011

J Obstet Gynecol India

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Objectives The purpose of the study was to compare the efficacy of misoprostol 400 lg per rectally, injection oxytocin 10 IU intramuscular, injection methylergometrine 0.2 mg intravenously and injection (0.5 mg ergometrine ? 5 IU oxytocin) intramuscular on reducing blood loss in third stage of labor, duration of third stage of labor, effect on haemoglobin of the patient, need of additional oxytocics or blood transfusion and associated side effects and complications. Study Design A prospective non-randomized uncontrolled study was carried out in the Department of Obstetrics and Gynecology, SSG Hospital and Medical College, Baroda enrolling 200 women and dividing them into four groups. Active management of 3rd stage of labor was done using one of the 4 uterotonics as per the group of the patient. The main outcome measures were the amount of blood loss, the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 h after delivery. Results Methylergometrine was found to be superior to rest of the drugs in the study with lowest duration of third stage of labor (P = 0.000096), lowest amount of blood loss (P = 0.000017) and lowest incidence of PPH (P = 0.03). There was no significant difference in the pre-delivery and the post-delivery hemoglobin concentration amongst the four groups with P = 0.061. The need of additional oxytocics and blood transfusion was highest with misoprostol as compared to all other drugs used in the study with P = 0.037 and 0.009, respectively. As regards side effects, misoprostol was associated with shivering and pyrexia in significantly high number of patients as compared to the other drugs used in the study while nausea, vomiting and headache were more associated with methylergometrine and ergometrine-oxytocin. However all the side effects were acceptable and preferable to the excessive blood loss. Conclusion Methylergometrine has the best uterotonic drug profile amongst the drugs used, strongly favouring its routine use as oxytocic for active management of third stage of labor. Misoprostol was found to cause a higher blood loss compared to other drugs and hence should be used only in low resource setting where other drugs are not available. The role of misoprostol in third stage of labor needs larger studies to be proved.Keywords Uterotonics Á 3rd stage of labor Á Post-partum hemorrhage Á Brass-V drapes

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Section: Resultsmentioning

confidence: 96%

A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine and Ergometrine–Oxytocin in Reducing Blood Loss in Active Management of 3rd Stage of Labor

Gohil

Tripathi

2011

J Obstet Gynecol India

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“…Prostaglandins are responsible for cervical ripening before labor and El-Refaey et al (1996) reported the first treatment of oral misoprostol for the management of the third stage of labour in an observational study. Since then misoprostol has attracted widespread attention because of its strong uterotonic and cervical ripening effects (Goldberg et al 2001).…”

Section: Discussionmentioning

confidence: 99%

Priming Effect of Misoprostol on Estrogen Pretreated Cervix in Postmenopausal Women

Atmaca

Kafkaslı

Burak

et al. 2005

Tohoku J. Exp. Med.

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[237][238][239][240][241] Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 ± 0.7 and 3.7 ± 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 ± 16.2 seconds for the estrogen group and 61.4 ± 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women. misoprostol; postmenopausal women; cervical ripening; estrogen

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“…Following earlier uncontrolled reports 2,3 of misoprostol use during the third stage of labour, a large multicentre trial was conducted by WHO to evaluate the effectiveness of 600 Ag misoprostol compared with 10 IU of oxytocin 4 . This large randomised controlled trial and a systematic review of seven randomised controlled trials 5 demonstrated that 10 IU of oxytocin (im or iv) is preferable to 600 Ag misoprostol given orally in the active management of the third stage of labour in hospital settings where active management is the norm.…”

Section: Introductionmentioning

confidence: 99%

Side effects of oral misoprostol during the first 24 hours after administration in the third stage of labour

Lumbiganon¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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For the WHO Collaborative Group to Evaluate Misoprostol in the Management of the Third Stage of LabourObjective To evaluate the side effects of 600 Ag misoprostol orally during the first 24 hours after administration in the third stage of labour. Design Double blind randomised controlled trial. Setting Tertiary care hospitals in Nigeria and Thailand. Sample All women participating in the WHO Misoprostol trial in these two hospitals between January 1, 1999and June 17, 1999. Methods All women were followed up during the first 24 hours postpartum to evaluate the occurrence of shivering, nausea, vomiting, diarrhoea and other misoprostol-related side effects. Main outcome measures Rates of shivering, nausea, vomiting, diarrhoea and pyrexia within 1 hour and in the intervals 2-6, 7-12, 13-18 and 19 -24 hours after delivery. Results A total of 1686 women were enrolled. Women who received misoprostol had higher incidence than the oxytocin group of 'any' shivering in the first hour (RR 6.4, 95% CI 3.9 to 10.4) and the period covering 2-6 hours following delivery (RR 4.7, 95% CI 1.9 to 11.2). Pyrexia was also more common in the misoprostol group in both the same time intervals (RR 2.8, 95% CI 1.4 to 5.3 and RR 6.3, 95% CI 3.7 to 10.8, respectively). Diarrhoea was not present in the first hour in either group but appeared in the second time period (2-6 hours) and third time period (7-12 hours) more frequently in the misoprostol group than with oxytocin. Conclusion The increased incidence of shivering and pyrexia that occurs with postpartum use of misoprostol persists up to 6 hours following delivery. Approximately 5% of women experience diarrhoea that starts after 1 hour and subsides within 12 hours.

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Misoprostol for third stage of labour

Cited by 67 publications

References 3 publications

A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine and Ergometrine–Oxytocin in Reducing Blood Loss in Active Management of 3rd Stage of Labor

A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine and Ergometrine–Oxytocin in Reducing Blood Loss in Active Management of 3rd Stage of Labor

Priming Effect of Misoprostol on Estrogen Pretreated Cervix in Postmenopausal Women

Side effects of oral misoprostol during the first 24 hours after administration in the third stage of labour

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