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

Authors

  • Moussa Diallo Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Toura Sylla Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Abdoul Aziz Diouf Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Phillipe Marc Moreira Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Omar Gassama Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Mame Diarra Ndiaye Gueye Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Marie Edouard Faye Dieme Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Mouhamadou Mansour Niang Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Jean Charles Moreau Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal
  • Alassane Diouf Department of Obstetrics and Gynecology, University Cheikh Anta Diop de Dakar, Senegal

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170373

Keywords:

Active management of the third stage of labour, Delivery, Misoprostol, Post-partum hemorrhage

Abstract

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.

References

WHO. Global estimates of maternal mortality for 1995: results of an in-depth review. analysis and estimation strategy. Geneva: WHO. 2001.

Direction de la statistique. Ministère de l’économie et des finances. Enquête démographique et de santé. Dakar. Sénégal. 2005.

Prendiville WJ. Harding JE. Elbourne DR. Stirrat GM. The Bristol third stage trial: active versus physiological management of the third stage of labour. BMJ. 1988;297(6659):1295-300.

Begley CA. Comparison of ‘active’ and ‘physiological’ management of the third stage of labour. Midwifery. 1990;6.1:3-17.

Khan GQ. John IS. Wani S. Teressa Doherti T. Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. Am J Obstet Gynecol. 1997;177(4):770-4.

Prendiville WJ. Elbourne McDonald S. Active versus expectant management in the third stage of labour (Cochrane Review. March 9. 2000). In: The Cochrane Library. Issue 4. Oxford: Update Software. Ltd. 2001.

Bamigboye AA. Merrell DA. Hofmeyr GJ. Ronald Mitchell R. Randomized comparison of rectal misoprostol with syntometrine for management of third stage of labor. Acta Obstet Gynecol Scand. 1998;77(2):178-81.

Cook CM. Spurret B. Murray H. A randomized clinical trial comparing oral misoprostol with synthetic oxytocin or syntometrine in the third stage of labour. Aust NZ J Obstet Gynaecol. 1999;39(4):414-9.

Diab KM. Ramy AR. Yehia MA. The use of rectal misoprostol as active pharmacological management of the third stage of labor. J Obstet Gynaecol Res. 1999;25:327-32.

Walley RL. Wilson JB. Crane JM. Matthews K. Sawyer E. Hutchens D. A double-blind placebo controlled randomized trial of misoprostol and oxytocin in the management of the third stage of labour. BJOG. 2000;107:1111-5.

Bulgaho A. Daniel A. Faundes A. Cunha M. Misoprostol for prevention of postpartum hemorrhage. Int J Gynec Obstet. 2001;73:1-6.

Ng PS. Chan ASM. Sin WK. Tang LCH. Cheung KB. Yuen PM. A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour. Hum. Reprod. 2001;16:31-5.

Gülmezoglu AM. Forn F. Villar J. Hofmeyr GJ. Prostaglandins in prevention of postpartum hemorrhage. Cochrane Data base Syst Rev. 2007;(3):CD 000494.

Darney PD. Misoprostol: a boon to safe motherhood or not? Lancet. 2001;358(9283):682-3.

Tang OS. Schweer H. Seyberth HW. Lee SW. Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17(2):332-6.

Bose P. Regan F. Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006;113(8):919-24.

El-Refaey H. Randa N. O’Brien P. Mona A. Geary M. Jane W. Choulnard CR. The misoprostol third stage of labour study: a randomised controlled comparison between orally administered misoprostol and standard management. BJOG. 2000;107(9):1104-10.

Afolabi EO. Kuti O. Orji O. Ogunniyi SO. Oral misoprostol versus intramuscular oxytocine in the active management of the third stage of the labour. Singapore Med J. 2010;51(3):207-11.

Zachariah ES. Naidu M. Seshadri L.nOral misoprostol in the third stage of labor. Int J Gynecol Obstet. 2006;92:23-6.

Chaudhuri P. Biswas J. Mandal A. Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women. Int J Gynecol Obstet. 2012;112(2):148-2.

Caliskan E. Meydanli MM. Dilbaz B. Aykan B.. Sonmezer M. Haberal A. Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial. Am J Obstet Gynecol. 2002;187(4):1038-45.

Singh G. Radhakrishnan G. Guleria K. Comparaison of misoprostol sublingual. intravenous oxytocin and intravenous methylergometrine in active management of third stage of labour. Int J Gynecol Obstet. 2009;107:130-4.

Villar J. Gulmezoglu AM. Hofmeyr GJ. Forna F. Systematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage. Obstet Gynecol. 2002;100:1301-12.

Kundodyiwa TW. Myor F. Rusakanik S. Misoprostol versus oxytocin in the third stage of labour. Int J Gynaecol Obstet. 2001;75:235-41.

Vimala N. Mittal S. Kumar S. Dadhwal S. Mehta S. Sublingual misoprostol versus methylergometrine for active management of third stage of labour. Int J Gynecol Obstet. 2004;87:1-5.

Hofmeyr GJ. Nikodem VC. De Jager M. Gelbart BR. A randomized placebo controlled trial of oral misoprostol in the third stage of labour. Br J Obstet Gynaecol. 1998;105:971-5.

Gülmezoglu AM. Villar J. Thi Nhu Ngoc N. Piaggio G. Carroli G. Adetoro L. et al. WHO multicentre randomised trial of misoprostol in the management of the third stage of labour. Lancet. 2001;358:689-95.

Lumbiganon P. Villar J. Piaggio G. Gulmezoglu M. Side effects of oral misoprostol during the first 24 hours after administration in the third stage of labour. BJOG. 2002;109:1222-6.

Oboro VO. Tabowei TO. J Obstet Gynaecol. 2003;23:13-6.

Gupta B. Jain V. Aggarwal N. Rectal misoprostol versus oxytocin in the prevention of postpartum hemorrhage- a pilot study. Int J Obstet Gynecol. 2006;94 suppl 2:s139-40.

Downloads

Published

2017-01-31

Issue

Vol. 6 No. 2 (2017): February 2017

Section

Original Research Articles