A comparative study of different route of administration of misoprostol in the management of third stage of labour
Keywords:Misoprostol, Post partum haemorrhage, Sublingual, Third stage of labour
Background: Post partum haemorrhage is the most common cause of maternal morbidity and mortality. Misoprostol is a prostaglandin analogue, used for management of post partum haemorrhage. It can be used by various routes with minimal side effects. This study is done to compare the different routes of administration of Misoprostol for the third stage management and their side effects. Objectives of present study were to estimate the amount of blood loss, to assess the maternal side effects of drug, to know the haemoglobin deficit, to know the duration of third stage of labour.
Methods: This was a prospective hospital base study of 150 women delivery at obstetrics and gynaecology department at ESICMC Model Hospital, Rajajinagar. They were randomized into 3 groups of 50 patients each. They received 400 µg of misoprostol either orally or rectally or sublingually immediately after delivery of the fetus. The primary outcomes analysed were amount of blood loss duration of third stage of labour haemoglobin deficit and their side effects
Results: The amount of blood loss and haemoglobin deficit was least in sublingual group which was statistically significant. Need of additional oxytocics was less in sublingual and oral group, though it was not statistically significant.
Conclusions: In the present study, sublingual Misoprostol was found to be more effective in reducing blood loss during third stage of labour.
Brandt M. The mechanism and management of third stage of labour. Am J obstet Gynecol. 1933;25:662-7.
WHO recommendations for the prevention of port partum Hemorrhage. Geneva WHO 2007.
EL-Rafaey H, Rodeck C. PostPartum Hemorrhage: Definitions, medical and surgical management. A time for change. Br Med Bull. 2003;67:205-17.
Donald I. PPH Practical Obstetric Problems. 5th ed. New Delhi. BI Publications;1998:753-794.
Mousa HA, Alfirevic L. Treatment of primary postpartum hemorrhage. Cochrane Database Syst Rev. 2003;1:CD003249.
Prendiville WJ, Elbourne D, McDonalds. Active versus expectant management of third stage of labour. Cochrane Database Syst Rev. 2000;3-7.
Prasertcharoensuk W, Swadpanich U, Lunbiganon P. Accuracy of the blood loss estimation in the third stage of labor. Int J Gynaecol Obstet. 2000;71:69-70.
International joint policy statement FIGO/ICM Global initiative to prevent port-partum hemorrhage. J Obstet Gynecol Can. 2004;26:1100-2.1108-11.
Song J. Use of misoprostol in obstetrics and gynaecology. Obstet Gynecol Surv. 2000:55(8):503-10.
Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90(1):88-92.
Chong YS, Chua S, Sheen L, Arul Kumaran S. Does the route of administration of Misoprostol make a difference? The uterotonic effect and side effects of misoprostol by different routes after vaginal delivery. Eve J Obstet Gynecol Reprod Biol. 2004;113:191-8.
Harwal N, Devarmani M, Melkundhi M. Management of 3rd stage of labour versus 125mcg PGF. J Evol Med Dental Sci. 2013;2(35):6717-22.
Hoj L, Cardoso P, Nielson BB, Hvidman L, Neilson J, Aaby P. Effect of sublingual Misoprostol on severe postpartum haemorrhage in a Primary Health centre in Guinea Bissau: randomised double blind clinical trial. BMJ. 2005;331:723.
un Nisa M, Nawaz R, Shamim R. Prophylaxis of atonic postpartum hemorrhage with misoprostol in underdeveloped countries. Annal King Edward Med Univ. 2009;15(4):185-9.
Bajwa SK, Bajwa SJ, Kaur H, Goraya SP, Singh A, KaurIshar H. Management of third stage of labor with misoprostol: A comparison of three routes of administration. Perspect Clin Res. 2012;3(3):102-8.
Rajaei M, Karimi S, Shahboodaghi Z, Mahboobi H, Khorgoei T, Rajaei F. Safety and efficacy of misoprostol versus oxytocin for the prevention of postpartum hemorrhage. J Pregnancy. 2014;2014.