Comparison of misoprostol in conjunction with oxytocin and oxytocin alone for the prevention of postpartum hemorrhage during active management of the third stage of labor

Background: When it occurs after a cesarean section or a normal vaginal delivery, postpartum hemorrhage (PPH) is a potentially fatal obstetric emergency. Aims and objectives: The aim of the study was to compare the efficacy and safety of oxytocin against oxytocin plus misoprostol in avoiding PPH during active management of the third stage of labor (AMTSL). Materials and Methods: Using simple randomization, 150 women from the labor ward of the Department of Obstetrics and Gynaecology at the Indore Medical College were recruited and randomly allocated to either test Group A or test Group B. Standard pharmacological treatment, including intramuscular injection of 10 IU of oxytocin and other components of AMTSL criteria, was administered to patients in Group A. In addition to the other components of the AMTSL criteria, Group B patients got the usual pharmacological treatment of 10 IU of oxytocin through the injectable route and 600 g of misoprostol through the oral route. Various characteristics of both groups were compared, including parity, gravida, delivery style, PPH etiology, blood transfusion, and surgical intervention. Results: Mode of delivery was vaginally seen in 85% and 92% and cesarean in 15% and 8%. Etiology was uterine atony in 54% and 64%, retained tissue in 26% and 12%, laceration in 11% and 18%, and coagulopathy in 9% and 6%. Blood transfusion was needed in 27% and 57% and surgical intervention in 82% and 68% in Groups A and B, respectively. A statistically significant difference was observed (P ? 0.05). Conclusion: The results of this study support the use of misoprostol in hospital settings as an adjunct to oxytocin since it reduces the incidence of PPH, eliminates the need for intrusive interventions, and ultimately reduces maternal mortality.

Prevention of Third Stage Bleeding by Using Misoprostol

Postpartum haemorrhage accounts for nearly 28% of maternalmortality in developing countries. This prospective study ofthird stage bleeding prevention was conducted among the 96patients, who got admitted into the OBGY units of DhakaMedical College Hospital for normal vaginal delivery. 96patients were allocated to receive either 600 µg misoprostolorally (57 patients) or rectally (37 patients) 5 min after cordclamping and cutting. The primary objective was to find outwhether there was any dissimilarity present between these tworoutes of misoprostol in case of blood loss in third stage oflabor. A total of 59 patients received 600 mug of misoprostolorally, while 37 rectally. Both groups were comparable indemographic and parital data.

Influencia del alumbramiento activo sobre la morbilidad materna por hemorragia posparto / Influence of active management of the third stage of labor upon maternal morbidity due to postpartum hemorrhage

Introducción: la hemorragia posparto constituye la principal causa de muerte materna en el mundo. El uso del alumbramiento activo puede disminuir la incidencia de esta fatal complicación. Objetivo: determinar la utilidad del alumbramiento activo sobre la morbilidad materna por hemorragia posparto. Métodos: estudio observacional, analítico, de corte transversal en 2 523 mujeres cuyos partos eutócicos se produjeron en el Hospital "Dr. Luis Díaz Soto" desde enero de 2003 a diciembre de 2007. Se compararon los efectos del alumbramiento activo con el expectante, en relación a la pérdida de sangre y otras complicaciones maternas. El manejo activo incluyó: administración de oxitocina después de salir el hombro anterior del feto, tracción controlada del cordón y contratracción por encima del hueso pubiano. Para el análisis se utilizó la prueba de chi cuadrado con un nivel de significación del 0,05. Resultados: del total de partos eutócicos, se le aplicó el método de alumbramiento activo a 1 364 casos (54,1 %) y expectante a 1 159 (45,9 %). El alumbramiento activo se relacionó con una menor necesidad de transfusión de sangre (0,8 % vs. 1.8) (p= 0,025) [RR = 2,25; LI= 1,09; LS 4,64], menor duración del tercer período del parto (0,3 % vs. 1,2 %) (p= 0,04) [RR= 3,53; LI 1,14; LS 10,92], necesidad de histerectomía puerperal e ingreso en unidad de terapia intensiva (0 vs. 0,35 %) (p= 0,03). La estadía posparto fue mayor en los casos de alumbramiento expectante (0,7 % vs. 0,4 %) (p= 0,04). Conclusiones: los resultados demuestran el factor protector del empleo del manejo activo del alumbramiento en las variables estudiadas, el cual debe ser utilizado de forma sistemática tras un parto eutócico de un embarazo sencillo.

Introduction: postpartum haemorrhage is the main cause of maternal death worldwide. Active management of the third stage of labor may reduce the incidence of this fatal complication. Objective: determine the usefulness of active management of third stage of labor with respect to maternal morbidity due to postpartum hemorrhage. Methods: analytical cross-sectional observational study of 2 523 women who had eutocic deliveries at Dr. Luis Díaz Soto Hospital from January 2003 to December 2007. A comparison was made of the effects of active and expectant management in terms of blood loss and other maternal complications. Active management included the administration of oxytocine upon emergence of the fetus's anterior shoulder, controlled traction of the cord, and counter traction above the pubic bone. The chi-square test was used for analysis, with a significance level of 0.05. Results: of the total eutocic deliveries, active management of the third stage of labor was used in 1 364 (54.1 %) whereas expectant management was used in 1 159 (45.9 %). Active management was associated with a lesser need of blood transfusions (0.8 % vs. 1.8 %) (p= 0.025) [RR = 2.25; LI= 1.09; LS 4.64], a shorter duration of the third stage of labor (0.3 % vs. 1.2 %) (p= 0.04) [RR= 3.53; LI 1.14; LS 10.92], a need for puerperal hysterectomy and admission to intensive care units (0 vs. 0.35 %) (p= 0.03). Postpartum stay was longer in expectant management cases (0.7 % vs. 0.4 %) (p= 0.04). Conclusions: results show the protective value of the use of active management of the third stage of labor for the variables studied, as well as the advisability of its systematic use after singleton pregnancy eutocic deliveries.

Alumbramiento asistido con oxitocina intraumbilical: expectante y rutinario

Objetivos: Comparar la eficacia y seguridad de los alumbramientos asistido con oxitocina intraumbilical, y expectante con clampaje parcial y rutinario, para disminuir el sangrado en la tercera etapa del parto. Diseño: Ensayo clínico controlado. Lugar: Hospital Vitarte del Ministerio de Salud, Lima, Perú. Participantes: Parturientas durante el alumbramiento. Intervenciones: En 180 gestantes elegidas aleatoriamente mediante un muestreo sistemático al ingresar a hospitalización del servicio de Obstetricia, se comparó tres formas de alumbramiento: a) asistido con oxitócica intraumbilical; b) expectante con clampaje parcial del cordón umbilical (de solo el lado fetal del cordón); y, c) rutinario o expectante con doble clampaje del cordón umbilical. En cada grupo ingresaron 60 gestantes. Principales medidas de resultados: Tiempo de alumbramiento, variación del hematocrito preparto y a las 24 horas posparto, y complicaciones. Resultados: Se observó reducción significativa del tiempo en los alumbramientos asistido y expectante frente al alumbramiento rutinario. Hubo reducción significativa en el hematocrito tanto en el manejo asistido como en el expectante, frente al manejo rutinario en pacientes que no tuvieron episiotomía. La hemorragia del alumbramiento no tuvo diferencias significativas. Conclusiones: Los alumbramientos asistido y expectante con clampaje parcial fueron más eficaces que el alumbramiento rutinario, con seguridad similar en los tres grupos.

Objectives: To determine efficacy and safety of assisted third stage of labor using intraumbilical oxytocin or either expectant or routinary. Design: Clinical controlled trial. Location: Hospital Vitarte, Ministerio de Salud, Lima Peru. Participants: Women in third stage of labor. Interventions: One hundred and eighty laboring women were randomized by systematic sampling when admitted for hospitalization. Three ways of third stage of labor management were compared: a) assisted, using intraumbilical oxytocin; b) expectant with partial clamping of the umbilical cord (by clamping only the fetal end of the umbilical cord); and c) routinary or expectant with double clamping of the umbilical cord. 60 pregnant women were randomized to each group. Main outcome measures: Duration of the third stage of labor, prepartum and 24 hours postpartum hematocrit, complications. Results: There was a significant reduction in the time of the third stage of labor and in the variation of the hematocrit values with the assisted management and the expectant method compared to routine management in patients who did not have episiotomy. There were no significant differences in puerperal hemorrhage. Conclusions: Assisted and expectant management of the third stage of labor were more efficacious compared to routine management of the third stage of labor. Safety was similar in the three groups studied.

Analysis of the Effect to Shorten the Third Stage of Labor and Reduce the Postpartum Hemorrhage by Umblilical Cord Exsanguination / 医学研究杂志

Objective To change the traditional disposal of the third stage of labor, we exsanguinate the placental blood from the maternal termination of umbilical cord after delivery, then the pressure of placental sinus decrease rapidly, the vessels contract, the placenta seperate from the uterine wall and expuse quickly, the third stage of labor is shortened and postpartum bleeding amount is decreased. Methods We chose 200 cases of vaginal delivery puerperants from October 2004 to August 2005 in our hospital as the test group (group A), 100 cases of vaginal delivery puerperants in the same period as the control group (group B). The statistics of the third stage of labor and the postpartum bleeding amount is made so as to evaluate and analyse the effect. Results In group A, the third stage of labor is obviously shortened and the postpartum hemorrhage is obviously reduced. There is singnificant difference between the two groups (P