Posted in Volume 15 - Number 2
SAFIA MAQSOOD SIDDIQUI, JAN MOHAMMOD SHAIKH, KAUSER AQIL JILLANI,MAQSOOD AHMED SIDDIQUI
ABSTRACT | Full Text PDF
Objective: The aim of this study was to compare the rectally administrated misoprostol 400 microgram with oxytocin 10 units I/V for the active management of the 3rd stage of labour for the prevention of primary postpartum haemorrhage and to assess the incidence and severity of the side effects of the both drug regimens.
STUDY DESIGN: Quasi-experimental study.
STUDY PERIOD: October 2006 – September 2007.
SETTING: Department of Gynaecology & Obstetrics Peoples Medical College & Hospital Nawabshah.
MATERIAL & METHODS: This study was carried out on 200 patients, misoprostol and oxytocin was given to 100 patients each. Women of any age and parity with singleton pregnancy delivered vaginally were included while those who refuses to give consent, with established PPH and have cesarean delivery were excluded . Data was collected on maternal and labour charactertstics. Active management of the 3rd stage of labour was done by giving misoprostol or oxytocin at delivery of the anterior shoulder of the baby and placenta was delivered by controlled cord traction and gentle uterine massage done after delivery of the placenta. Women were observed up to one hour after the delivery and blood loss was collected in measured container. Treatment outcomes were recorded, like duration of 3rd stage, total blood loss and postpartum side effects of the drugs. Statistical analysis was performed by using chi square and student’s t-test. A p-value of <.05 was considered statistically significant.
RESULTS: No women in both groups had prolonged 3rd stage of labour. Mean 3rd stage duration of misoprostol group was 5.70 (SD = 4.25) and oxytocin group was 6.04 (SD= 4.25). Mean blood loss was greater in misoprostol group (p < 0.3). PPH developed in 36 % misoprostol group and 30 % in oxytocin group (p < 0.250). Uterine atony remained the commonest cause of PPH in both group. No patient in both groups had retained placenta. Postpartum side effects were more in the misoprostol group, 6 % had fever, 4 % had shivering, 1 % had nausea, 1 % had headache and 1 % had abdominal pain. While in oxytocin group, 7 % had fever and 2 % had shivering (p < 0.010). In both groups, primary PPH was well managed, without surgical intervention and none of the maternal death recorded.
CONCLUSION: PPH occurred more frequently in the 400 mg rectally administrated misoprostol when compared to 10 units intravenous oxytocin although statistically not significant. Considering the safety of rectal route of misoprotal as compared to oral route administration, it just needs a dose adjustment for improving its safety.
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