Randomized comparative study of oral misoprostol with intravenous methyl ergometrine in prevention of postpartum haemorrhage in cases high risk for postpartum haemorrhage

Humera, Aisha; Kerure, Sudha Biradar

doi:10.18203/2320-1770.ijrcog20160587

Cited by 3 publications

(4 citation statements)

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“…This may be due to high risk patients employed in the study. 1 In a study done by Amant, a randomized controlled trial, both intravenous methergin and misoprostol were equally effective. The side effects associated with methyl ergotamine were more.…”

Section: Discussionmentioning

confidence: 99%

“…Atony of uterus is implicated in 70% of cases of PPH and sometimes extensive surgical measures are required for its remedial. 1,2 Most tested treatment for atonic postpartum hemorrhage starts with methyl ergotamine, oxytocin and prostaglandins. Though many clinicians use IV Oxytocin to decrease blood loss during third stage but it was seen around half of females required other uterotonic drugs like Ergot Alkaloids or Prostaglandins.…”

Section: Introductionmentioning

confidence: 99%

“…In another study conducted by Humera in India misoprostol and methyl ergotamine were found to be equally effective. 1,2 The rationale was to conduct a study in our study due to conflicting evidence for determining whether this cheap & widely used misoprostol is better to prevent PPH than Methyl ergotamine which is also one of the favored drug in reduction of blood loss in the third stage of labour.…”

Section: Introductionmentioning

confidence: 99%

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Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

Imran

Wajid

Janjua

2020

Pak Postgrad Med J.

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BACKGROUND Postpartum hemorrhage is a very important cause of maternal mortality worldwide. According to WHO, 20 million of morbidities and 33 % of maternal mortality can be attributed to PPH worldwide. WHO states that misoprostol can also be used to prevent PPH, due to its beneficial effects in low income settings. OBJECTIVE The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing blood loss with that of methyl ergotamine in first two hours after delivery. METHODOLOGY It was a randomized controlled, single center, double blind trial of sublingual misoprostol versus intravenous methyl ergotamine for control of blood loss in 82 women with singleton pregnancies at term who underwent delivery at Sir Ganga Ram hospital. Participants were divided randomly into two groups (A and B). Randomization was done by Microsoft Excel 5.0 random number generator. The participants were given either misoprostol 600 micrograms sublingually immediately or injection methyl ergotamine 0.2 mg at time of delivery of anterior shoulder of baby. The outcome measures studied were blood loss, blood transfusions, drop in hemoglobin and side effects of both drugs. RESULTS Mean age of women in Misoprostol group was 25.76±3.48years. Mean age of methyl ergotamine was 26.0 3.67 years Mean gestational age of women in Misoprostol group was 39.73±1.32 and mean gestational age of women in methyl ergotamine group was 40.09±1.22 weeks. Before delivery mean Hb level was statistically same in both group but post-delivery mean Hb level was significantly dropped in other group. I.e. p-value=0.000165.In Misoprostol group none had blood transfusion while in methyl ergotamine group 4(9.76%) women had blood transfusion but this difference was not statistically significant. Nausea, vomiting and hypertension were significantly higher in methyl ergotamine group. However for pyrexia and shivering an opposite trend was seen for Misoprostol when compared with methyl ergotamine. CONCLUSION Results of this trial showed that sublingual misoprostol is more effective as compared to intravenous methyl ergotamine. It has many advantages including easy transport, storage and oral route which make it a good uterotonic agent in low-resource areas. It was also associated with lesser side effects

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

Imran

Wajid

Janjua

2020

Pak Postgrad Med J.

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“…Therefore, supervision and prevention of PPH are the main concern. 4,5 In general, 88% of PPH takes place during four hours after delivery and anemia is the risk factor for massive PPH among pregnant women in developing countries. 6 Clinicians often use some types of prostaglandin in fourth stage of labor to prevent PPH; however, active management of third stage had been properly done.…”

Section: Abstrakmentioning

confidence: 99%

Effect of Rectal Misoprostol to Blood Loss at High Risk Pregnancy

Liando

Manoe

Moeljono

2017

Indones J Obstet Gynecol

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Objective: To compare the effectiveness of rectal misoprostol administration to the amount of blood loss in 4th stage of labor at high risk pregnancy. Method: We recruited all pregnant women with high risk criteria including anemia, age  35 years old, or the number of pregnancies  4. Women would deliver appropriate to standard procedure of normal delivery. After that, we gave 400-mcg tablet of misoprostol rectally in treatment group. To count the amount of blood loss during 4th stage of labor, we put the underpad. Result: The amount of blood loss in 4th stage of labor in the treatment group was 201.1 (SD 80.3) ml less than the control group (285.9 (SD 93.2) ml). The result showed that the administration of 400-mcg misoprostol tablet rectally immediately after the birth of the placenta at high risk pregnancy impacted significantly to reduce the amount of blood loss in 4th stage of labor (p

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Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

Gallos

Papadopoulou

Man

et al. 2018

Cochrane Database of Systematic Reviews

131

183

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Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic agents can prevent PPH, and are routinely recommended. The current World Health Organization (WHO) recommendation for preventing PPH is 10 IU (international units) of intramuscular or intravenous oxytocin. There are several uterotonic agents for preventing PPH but there is still uncertainty about which agent is most effective with the least side effects. This is an update of a Cochrane Review which was first published in April 2018 and was updated to incorporate results from a recent large WHO trial. Objectives To identify the most effective uterotonic agent(s) to prevent PPH with the least side effects, and generate a ranking according to their effectiveness and side‐effect profile. Search methods We searched the Cochrane Pregnancy and Childbirth’s Trials Register, , the World Health Organization (WHO) International Clinical Trials Registry Platform ( ) (24 May 2018), and reference lists of retrieved studies. Selection criteria All randomised controlled trials or cluster‐randomised trials comparing the effectiveness and side effects of uterotonic agents with other uterotonic agents, placebo or no treatment for preventing PPH were eligible for inclusion. Quasi‐randomised trials were excluded. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved. Data collection and analysis At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. Secondary outcomes included blood loss and related outcomes, morbidity outcomes, maternal well‐being and satisfaction and side effects. Primary outcomes were also reported for pre‐specified subgroups, stratifying by mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of administration. We performed pairwise meta‐analyses and network meta‐analysis to determine the relative effects and rankings of all available agents. Main results The network meta‐analysis included 196 trials (135,559 women) involving seven uterotonic agents and placebo or no treatment, conducted across 53 countries (including high‐, middle‐ and low‐income countries). Most trials were performed in a hospital setting (187/196, 95.4%) with women undergoing a vaginal birth (71.5%, 140/196). Relative effects from the network meta‐analysis suggested that all agents were effective for preventing PPH ≥ 500 mL when compared with placebo or no treatment. The three highest ranked uterotonic agents for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, misoprostol plus oxytocin combination and carbetocin. There ...

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Randomized comparative study of oral misoprostol with intravenous methyl ergometrine in prevention of postpartum haemorrhage in cases high risk for postpartum haemorrhage

Cited by 3 publications

References 5 publications

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

Effect of Rectal Misoprostol to Blood Loss at High Risk Pregnancy

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

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