Severe vaginal bleeding secondary to cesarean scar dehiscence following incomplete abortion management

Severe uterine bleeding is not a common presentation of cesarean section scar dehiscence in the first trimester. We present a 41-year-old lady with uterine scar dehiscence that was probably secondary to uterotonic medication used for the management of first trimester incomplete abortion. The use of uterotonic medications [Methergine] may be a contributing factor in this case. It should be used with caution in patients with previous uterine scar

Is treatment with oral or rectal misoprostol effective to prevent postpartum hemorrhage?

To compare the efficacy of 400 mg of oral or rectal misoprostol with 0.2 mg intramuscular methylergometrine to prevent postpartum hemorrhage [PPH]. 672 women were randomized into three groups: Group 1 received 400 mg misoprostol orally [n =240], Group 2 received 400 mg misoprostol rectally [n = 222], and Group 3 received 0.2 mg methylergometrine IM [n =210]. The mean blood loss, PPH >/= 500 ml, needs for additional oxytocic drugs, and decrease in hemoglobin concentration were the main outcomes measured. The demographic characteristics were comparable. There were no significant differences among the three groups in mean blood loss [P = 0.112], incidence of PPH >/= 500 ml [P=0.334], need for additional oxytocic agents [P=0.574], and decrease in mean hemoglobin concentration [P=0.613]. Significant differences detected with the use of misoprostol whether given orally or rectally, were elevated temperature >/= 38°C [P= 0.002] and shivering [P=0.001]. Oral or rectal misoprostol is as effective as conventional, intramuscular methylergometrine in preventing postpartum hemorrhage, and the drug has the advantages of stability at room temperature and ease of administration. It can be recommended for routine use anywhere for prevention of PPH

Comparison between rectal misoprostol and intramuscular oxytocin/methergine for the management of the third stage of labor

Two groups of parturient women, each one hundred, were given either 400 ug misopristol rectally or combination of 5 IU oxytocin and 0.2 mg methergine IM for the management of the third stage of labor. Misoprostol group had shorter third stage of labor, less blood loss and post partum hemorrhage, less incidence of manual removal of the placenta and less side effects. Rectal misoprostol is safe, effective, and cheep drug for the management of the third stage of labor as a primary line of treatment or in cases in which oxytocin / methergine fail to control post partum hemorrhage