Prophylaxis of Atonic Postpartum Hemorrhage with Misoprostol in Underdeveloped Countries

Abstract

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Background:  In this modern era of 21st century, postpartum hemorrhage is still the leading cause of maternal mortality in poor countries. In 70% cases, the cause is uterine atony. For centuries a therapy was needed which should be effective, cheap, safe, does not need refrigeration and that can be easily administered by untrained staff to control postpartum hemorrhage at primary health care setting in underdeveloped countries where majority of maternal deaths due to PPH occur. Misoprostol is one drug that might fulfill these requirements.

Objectives:  The objective of this study is to evaluate the efficacy of rectal misoprostol in the prophylaxis and management of atonic PPH and compare it with conventional I/V syntocinon routinely used in hospitals as part of active management of third stage of labor.

Study Design:  Semi experimental.

Materials and Methods:  The study was conducted in Services Hospital Lahore, Department of Gynecology unit-2, between Oct 2006 to March 2007.One thousand pregnant females were included in the study and divided into two groups, a control group (500 women who received syntocinon) and a study group (500 women who received rectal misoprostol). Syntocinon (Sandoz Pharmaceuticals) 5u I/V injection and misoprostol (Cytotec, Searle Pharmaceuticals) 600 ug (3 tablets) per rectum were given to women in control and study group respectively, immediately after delivery of the baby. Duration of third stage of labor, blood loss after delivery, and hemoglobin deficit after 24 hours of delivery and frequency of atonic PPH were recor-ded and compared between the two groups. The side effects of both drugs were also noted.

Results:  There was not a significant difference in blood loss after delivery (control group - 252 ml, study group - 304 ml, p-value - 0.18), duration of third stage of labor (control group-14.74 minutes, study group-16.54 minutes, p-value - 0.17) and hemoglobin deficit (control group - 0.375 gm/dl, study group - 0.404 gm/dl, p-value - o.5) between both groups. The fre-quency of atonic PPH in study and control group was similar ranging between 3 to 4%.Side effects of misoprostol (shivering 25%, fever 15%, vomiting 12% and diarrhea 5%).were significant (p-value <0.05) but all were temporary and not life thre-atening.

Conclusion:  Misoprostol may be used for managing third stage of labor to reduce atonic PPH, especially in poor countries where facilities to deliver in hospitals and storage of oxytocic ampoules or medically trained persons are not readily avai-lable. Benefits of misoprostol outweigh its side effects.

Key Words:  Prophylaxis, atonic postpartum hemorrhage, rectal, misoprostol, syntocinon, underdeveloped countries.