Place of the misoprostol in 600 µg in intrarectale in case of hemorrhage of the post partum by uterine atony at the Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar


  • Rainibarijaona Lanto Nirina Aimé Department of Obstetrics and Gynecology, Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar
  • Rakotonirina Andriamaro Martial Department of Obstetrics and Gynecology, Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar
  • Ratsiatosika Andriamanetsiarivo Tanjona Department of Obstetrics and Gynecology, Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar
  • Randriamahavonjy Romuald Department of Obstetrics and Gynecology, Soavinandriana Hopital Center, Antananarivo, Madagascar
  • Andriamihajason Lovamampionona Department of Obstetrics and Gynecology, Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar
  • Hery Rakotovao Andrianampanalinarivo Department of Obstetrics and Gynecology, Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar



Atony, Emergency, Hemorrhage, Misoprostol, Obstetrical, Uterotonic


Background: The hemorrhage of the post-partum (HPP) represents a major problem of public health because it hires the vital and obstetrical forecast of the mother in case of delay of taking care. Present study aims at assessing the effectiveness of the administration of 03 tablets of misoprostol in intra-rectal in the taking care of HPP by uterine atony and to determine the épidémio-clinical profile of HPP by atony.

Methods: Authors performed a retrospective and descriptive study concerning the effectiveness of the misoprostol in the taking care of HPP by uterine atony. This study started from December 1st, 2016 till March 31st, 2017. The data processing was performed by Epi info 7 and Excel.

Results: The rate of HPP represented 3.8% deliveries which 69.4% was due to uterine atony. HPP by uterine atony represented 2.60% deliveries. It happened at the women from 25 to 34 years old (46.16%), pauciparous (76.93%), with a lower working time at 8 hours (71.15%) and having performed at least 4 CPN (63.47%), giving of urgent babies with a medium weight of 3073.43 g. The administration of the misoprostol was efficient in 90.40% and we noticed no side effect or of serious complications during the taking care of HPP by uterine atony.

Conclusions: HPP remains another major preoccupation of the obstetricians in our country because it is an emergency that can put into play the vital forecast and which requires a catch in quick load. The administration of 03 tablets (600 µg) of misoprostol in intra-rectal during HPP by uterine atony deserves its place in the armory of taking care because it is a sure method, efficient and easy to manipulate.


John W, Snelgrove MD. Postpartum haemorrhage in the world developing: a revision of clinical strategies of direction. Branchie of master of formalities. J Med On. 2009;12(2):61.

Khan KS, Wojdyla D, Disons L, Gulmezoglu AM, Look PF. WHO (WHICH): analysis of reasons of maternal death: a systematic revision. Lancet. 2006;367(9516):1066-74.

Potts M, Pratta N, Sahin hodoglugil NN. Hemorrhage of the postpartum: prevention and lever charge demi-cadratin. Lancet. 2010;375(9728):1762-3.

Prendville WJ, Harding ME, Elbourne DR, Stirrat GM-Le. Trial of third stage of Bristol board: assets counter the physiological direction of third working stage. Brit Med J. 1988;297(6659):1295-300.

WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organisation, 2012. Available at:;jsessionid=2C3012951F28BC1630166C05163B06B7?sequence=1.

Roberts WE. Young obstetrical direction of postpartum hemorrhage. Obstet Gynecol Clin North Am. 1995;22(2):283-302.

Joseph KS, Roll J, Kramer MRS, Liston RM, Baskett TF. Inquiry of an increase of postpartum hemorrhage in Canada. Br J Obstet Gynaecol. 2007;114(6):751-9.

Tharaux DC, Dupont C, Hake N, Rabilloud M, Touzet S, Lansac J. Others intervention with numerous facets to diminish the rate by postpartum strict hemorrhage: the Pithagore group has controlled trial randomized. Brit J Obstet Gynaecol. 2010;117(10):1278-87.

Tessier V, Pierre F. Factors of in the course of labour and the clinical and pharmacologic prevention of the hemorrhage of the post partum. J Rep Gynecol Obstet Biol. 2004;33(8):29-56.

Callaghan WM, Kulkina EV, Berg CJ. Tendencies in postpartum hemorrhage: the United States, on 1994-2006. J Obstet Gynecol. 2010;202(4):2531-6.

Youssoufi, Khattou A, Moussaid, Salmi S, Miguil. Maternal mortality graves of postpartum hemorrhages. Casablanca. The Morocco. SRLF and Springer - Verlag France. 2011.

Chichakli LO, Atrash HK, Mackay AP, Musani AS, Berg CJ. Mortality linked by the pregnancy to the United States because of hemorrhage: On 1979-1992. Obstet Gynecol. 1999;94:721-5.

Wangala P, Rhietmuller D, Ngueyen J, Mallet R, Colette C. Unrecognized hemmorrages during delivery. Rev Fr Gynecol Obstet. 1995;90(4):215-9.

Report of the National Expert Committee on Maternal Mortality (CNEMM), France, 2001-2006.

Kastner ARE, Figueroa R, Garry D, Manlik D. Emergency peripartum hysterectomy: experience to a community. Obstet Gynecol. 2002;99:971-5.

Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahir G, hysterectomy of Kamaci M. Peripartum in a hospital teaching in the region from the east of Turkey. Euro J Repetit Obstet Gynecol Biol. 2005;120:57-62.

Julie J. UHP University Henry Poincaré. The lever accuses demi - cadratin that of hemorrhage the tomb of post partum. Citizens of Impact of recommendations of 2004 in a motherhood of level II on October 24th; 2011.

Alihonou E. The hemorrhages of deliverance, statistical study and the étiologique regarding 151 listed cases demi-cadratin 5 years. Publ Med Afr. 2002;121:8-11.

Deneux-Tharaux, Bonnet MP. Epidémiologie of the hemorrhage of the post partum. 2014;43(10):936-60.

Mbizvo M, Fawcus S, Lindmark G, Nystrom L. Maternal Mortality study the group. Operational factors of maternal mortality in Zimbabwe. Plan of health Politics. 1993;8(4):369-78.

Subtil D, Summa A, Ardiet E, Depret-Mosser J. Clinical Practice Recommendation. Postpartum haemorrhage: frequency, consequence in terms of health and risk factors before delivery. J Gynecol Obstet Biol Reprod. 2004;33(8):4S9-16.

Descargues G, Pipette P, Roman H, JP Lemoine, Marpeau L. Undiagnosed hemorrhages of the postpartum. J Obstet Gynaecol Biol Reprod. 2001;30(6):590-600.

Hertz H, Sokol R J, Dierker W. Treatment of postpartum uterine atony with prostaglandin E2 vaginal suppositories. J Obstet Gynaecol. 1980;56(1):129-30.

Mocanu EV, Greene RA, Byrne BM, Turner MJ. Obstetric and neonatal outcome of babies weighing more than 4.5kg: an analysis by parity. Eur J Obstet Gynecol Reprod Biol. 2000;92:229-33.

Osefo J. Ceasarean and postpartum hysterectomy in Enugn, 1973-1986. Int J Obstet Gynecol. 1989;30:93-7.

Shojai R, Piechon L, C of Ercole, Boubli L, Pontiès JE. Misoprostol rectally in the hemorrhages of the delivery. J Gynaecol Obstet Biol Reprod. 2001;30(6):572-5.

Caliskan E, Meydanli MM, Dilbaz B, Aykan B, Sonmezer M, Haberel A. Is rectally effective in the treatment of third stage of labor? A randomized controlled trial. Am J Obstet Gynecol. 2002;187:1038-45.

Miller S, Fathalla MMF, Ogengbede O, Camlin C, Youssif M, Bello MIO, et al. Obstetric hemorrhage and shock management using the low technology Non pneumatic anti shock Garment in Nigerian and Egyptian tertiary care facilities. Bio Med Central Pregnancy Childbirth. 2010;10:64.

Leon W, Durocher J, Barrera G, Pinto E, Winikoff B. Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make? Bio Med Central Pregnancy Childbirth. 2012;12:65.

Blum J, Alfirevic Z, Weeks A, Winikoff B. Treatement of postpartum hemorrhage with misoprostol. Int J Obstet Gynecol. 2007;99:S202-5.

Hofmeyer GJ, Ferreira S, Nikodem VC, Mangesi L, Singata M, Jafta Z, et al. Misoprostol for treating post partum hemorrhage: a randomized controlled trial. Br J Obstet Gynaecol. 2004;111(9):1014-9.

Khan. Oral, rectal and vaginal pharmacokinetics of misoprostol. Obstet Gynecol. 2004;103(5-1):866-70.

EI-Refaey H, O’Brien P, Morafa W, Walder J, Rodeck C. Use of oral misoprostol in the prevention of postpartum haemorrhage. Br J Obstet Gynaecol. 1997;104:336-9.

Patted SS, Goudar SS, Naik VA, Bellad MB, Edlavitch SA, Kodkany BS, et al. Side effects of oral misoprostol for the prevention of postpartum hemorrhage: Result of a community-based randomized controlled trial in rural India. J Mattern Fetal Neonatal Med. 2008;16:1-5.

Bisharah M, Tulandi T. Side effects of sublingual misoprostol and insemination terminate study. Reprod Bio Med. 2002;22:637.

Lumkiganon P, Hofmeyr J, Gulmezoglu AM, Pinol A, Villar J. Misoprostol dose related shivering and pyrexia in the third stage of labour. Br J Obstet Gynaecol. 1999;106:304-8.

Tang OS, Schweer H, Seyberth HW, Ho PC. Pharmacokineticks of differents routes of administration of misoprostol. Hum Reprod. 2002;17(2):332-6.






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