Sublingual misoprostol versus methylergometrine for active management of the third stage of labor

Vimala, N.; Mittal, Suneeta; Kumar, Sudhir; Dadhwal, Vatsla; Mehta, Samira K.

doi:10.1016/j.ijgo.2004.05.016

Cited by 41 publications

(48 citation statements)

References 12 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: 59%

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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: 59%

“…This cut‐off value was based on reports of a mean pre‐delivery haemoglobin of 9.8 g/dl among women in India 14, 15, 16. A drop to 7.8 g/dl would approximate a clinically relevant 2 g/dl decrease in pre‐ to post‐delivery haemoglobin and is below the value considered indicative of moderate to severe anaemia (9.0 g/dl) 17.…”

Section: Methodsmentioning

confidence: 99%

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 decline of hemoglobin in MO group significantly was smaller than O and M groups. We chose to administer misoprostol sublingual route to allow fast absorption of drug and more effective and sustained therapeutic effect, although other studies presented no difference (between) buccal or sublingual misoprostol inhemorrhage control [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Pakniat

Khezri

2015

J Obstet Gynecol India

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About the Author AbstractPurpose To compare the effect of combined oxytocinmisoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery. Methods One hundred fifty patients of 18-40 years with singleton term pregnancies scheduled for cesarean section under spinal anesthesia were recruited in a prospective double-blind randomized clinical trial to one of the three following groups to receive 20 IU infusion of oxytocin (group O), 400-lg sublingual misoprostol tablets (group M) or 200-lg misoprostol plus 5 IU bolus intravenous oxytocin (group MO) after delivery. The hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded. Results The mean blood loss during surgery was significantly lower in group MO compared to other groups (P = 0.04). Comparison of mean arterial pressure (P = 0.38) and heart rate (P = 0.23) changes during spinal anesthesia and surgery failed to reveal any statistically significant differences between all groups through repeated measure analysis. Conclusion The use of combined lower dose of misoprostol-oxytocin significantly reduced the amount of blood loss during and after the lower segment cesarean section compared to higher dose of oxytocin and misoprostol alone, and its use was not associated with any serious side effects.

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“…And Cook with 22% for 400 mcg per os. 17,18,25 No superiority of one treatment over the other was noted in the various studies where 400/500 mcg of misoprostol per os/perlingual was compared to oxytocin and/or Syntometrine®. 9,10,19,21,23 It shall be noted that Cook.…”

Section: Misoprostolmentioning

confidence: 99%

Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

Diallo¹,

Sylla²,

Diouf³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Assess the effectiveness of oral misoprostol as an alternative to oxytocin in the active management of the third stage of labour in Dakar/Senegal.Methods: Randomized controlled clinical trial conducted in the maternity ward of a university hospital on 304 women who had vaginal delivery. These women were randomly assigned into 2 groups based on active delivery conditions: the first group received an oral administration of misoprostol (400 mcg) and the second group 5 IU oxytocin through intravenous route.Results: The average volume of blood loss was 196.55 ml in the misoprostol group and 208.39 ml in the oxytocin group (p=0.63). The incidence of postpartum haemorrhage (>500 cc) was 6.49% in the misoprostol group and 9.33% in the oxytocin group (p=0.358). The average rate of haemo globin decline was 0.38 g/dl in the misoprostol group and 0.29 g/dl in the oxytocin group (p=0.99). The proportion of hyperthermia, shivering, and nausea in the misoprostol and oxytocin groups were respectively: 2.59% against 0.6% (p=0.123), 7.14% against 2% (p=0.001) and 2.59% against 0.6% (p=0.498).Conclusions: In Senegal, Misoprostol despite its side effects, is an effective alternative to oxytocin in the active management of the third stage of labour for low-risk parturient women to reduce the risk of maternal deaths due to post-partum hemorrhage.

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Sublingual misoprostol versus methylergometrine for active management of the third stage of labor

Abstract: Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.

Cited by 41 publications

References 12 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

The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

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