Different doses of sublingual misoprostol versus methylergometrine for the prevention of atonic postpartum haemorrhage

In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage [PPH] is the most common cause of death Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and 1000 micro g in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag [APPH]. Double blind randomized controlled study. One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 micro g tablets were given to women in control and the three study groups respectively, immediately after delivery. Outcome Measures: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non-anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration. Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 M9 and 1000 micro g. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related. Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects

El-Menia air inflated balloon in controlling atonic post partum hemorrhage

To design and test an in-expensive air-inflated balloon that is easy to sterilized and use for the control of atonic post partum hemorrhage [APPH]. Primary outcome measure: Maternal Mortality [MM]. Secondary outcome measures: Surgical maternal morbidities, amount and doses of drugs, blood transfusion units used for resuscitation, general condition of women on admission and outcome on discharge, the resuscitation time and time for Technical outcomes: Incidence of Balloon rupture, allergic manifestations and pyrexia. Randomized clinical trail/ cross over study Two hundred and forty women with diagnosis of atonic PPH complicating vaginal deliveries were randomly assigned to be managed either by ecbolics and uterine massage as recommended by the WHO; or by WHO protocol plus El-Menia air inflated balloon. No maternal mortality in either group. The maternal morbidities in the form of surgical intervention [uterine and ovarian artery ligation, uterine compression suture, internal iliac artery ligation and abdominal hysterectomy] were observed in five women in controls and non in the studied women. Blood transfusion units, ecobolic drugs, resuscitation time, regaining uterine tone time, hospital stay and ICU admission were significantly less in studied women than controls. Out of the 19 failure to arrest APPH in the controls; 14 cases responded to secondary application of El-Menia balloon, and only five cases required surgical intervention. El-Menia balloon in an inexpensive, easy to apply, effective in controlling APPH with minimal side effects. It is targeted for use on a large scale in developing countries to reduce the maternal mortality and morbidity caused by APPH

Different doses of sublingual Misoprostol versus Methylergometrine for the prevention of atonic Postpartum Haemorrhage

Objective: In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage [PPH] is the most common cause of death. Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and1000Mug in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag [APPH]

Study Design: Double blind randomized controlled study

Methods: One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 Mug tablets were given to women in control and the three study groups respectively, immediately after delivery. Outcome Measures: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration

Results: Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 Mug and 1000 Mug. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related

Conclusion: Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects

Identification of biochemical changes in intractable postpartum hemorrhage and evaluation of the different methods used in management

To find out the possible causes for inability of the smooth muscle fibers of the uterus to contract in cases with postpartum hemorrhage in response to ecbolics and evaluation of the different methods used in management. This study included 200 women, 100 of them delivered and developed postpartum hemorrhage [the study group] which was divided into two subgroups, the first subgroup included 75 women that responded to conservative and medical methods of treatment of postpartum hemorrhage, the second subgroup included 25 women who did not respond. The other 100 women delivered and not developed postpartum hemorrhage [the control group]. The cases included in this study were [of atonic postpartum hemorrhage], of all parities, without rupture uterus, retention of the placenta, genital tract laceration or blood coagulation defects. Blood samples: [10 cm each] were taken from each patient for determination of hemoglobin percentage, complete blood analysis, random blood sugar, urea and creatinine, serum sodium and potassium and coagulation profile. Another sample [10 cm] was taken for nitric oxide assay and determination of plasma lipid peroxides. The routine medical managements used for treatment of postpartum hemorrhage were done for all cases. Surgical managements were done for the non-responding cases. In relation to the risk factors for development of postpartum hemorrhage, the study group was more anemic, with more antepartum hemorrhage, more malpresentation, more multiple pregnancies, more polyhydramnious and more manipulation outside the hospital than the control group and the differences were statistically significant. There was more prolonged labor and prolonged rupture of membranes in the study group than in the control group but there was no difference in relation to the mode of delivery. There was significant difference in relation to the level of plasma lipid peroxides [P value<0.01] and serum nitric oxide [P value<0.001] between the study group and the control group. The level of plasma lipid peroxides and serum nitric oxide was elevated in the intractable subgroup more than in the responding one and the difference was statistically significant [P<0.001]. Twenty five cases did not respond to the medical methods used for treatment [the intractable subgroup], they were of high parity, more anemic and of more medical disorders than the responding subgroup [75 cases responded for medical methods] and the differences were statistically significant. The surgical methods [conservative one] succeeded in 19 cases of 25 who failed to respond to medical treatment with a percentage of 76%. The remaining 6 cases, hysterectomy was done and succeeded in 3 cases only with a percentage of 50%. The other 3 cases died later on from pulmonary embolism, renal failure and DIC. Elevation of the level of free radicals as plasma lipid peroxides and serum nitric oxide was more markedly evident in the cases that failed to respond to the medical methods and ecbolic drugs used in control of postpartum hemorrhage [Intractable cases]. This elevation in free radicals, most probably, was due to cellular injuries of the uterine muscle fibers as a result of hypoxia and anoxia resulting from failure of correction of blood loss rabidly in cases of postpartum hemorrhage. Thus early and rapid correction of blood loss especially by fresh blood can prevent this vicious circle and prevent cellular injury in cases of postpartum hemorrhage. It is advisable not to rush to do urgent hysterectomy without performing the other conservative surgical methods for controlling of postpartum hemorrhage, as they succeeded in more than 75% of cases

Is Ramadan fasting hazardous for the pregnant mother and the fetus?

Biochemical changes in the pregnant mother and biophysical profile changes in the fetus were studied in Ramadan fasting pregnant women. This longitudinal study did not show any significant change in serum levels of Na [+], K [+], low-density cholesterol and total cholesterol, Apolipoproteins A, A[1] B and fetal biophysical profile, through the whole month they did not show any significant change. Fetal growth parameters were not significantly different from standard growth curve. Fasting Ramadan for a healthy pregnant woman without pregnancy complications may not be hazardous for the mother and her fetus

Comparison between growth of infants of working and non-working mothers in El-Minia city

This work was carried out to study the impact of work of mothers on the anthropometric measurements of the infants in El-Minia City. A follow-up of infants of 500 working mothers was done during the first year of life. 458 infants [244 males and 214 females] were followed up by anthropometric measurements [weight, length and head circumference] at birth and monthly up to 12 months. The measurements were compared with measurements of 244 infants [126 males and 118 females] of non-working mothers. The results revealed that there was a significant difference between both groups of infants in achieving physical growth during the first year of life [P < 0.05]. All measurements were compared with National Center of Health and Statistics USA [NCHS-USA] growth chart. In the present study, the irregularity in practice of breast feeding and lack of time for daily care and proper nutrition as regards working mothers were the most common causes of under growth of infants of working mothers during the first year of life

Fetal growth and pregnancy outcome in working and non-working pregnant women in El Minia City

Seven hundred and fifty pregnant women were studied in two groups: group one consisted of 500 pregnant women who were employed in different jobs while group two consisted of 250 pregnant women who were non-working. The study involved clinical and ultrasonic examinations to measure the biparietal diameter and femur length, as well as hormonal assay to the effect of different kinds of work on the outcome of pregnancy. The working pregnant women had higher percentage of premature labour, lower birth weight, an increased incidence of stillbirth and neonatal mortality than the non-working pregnant women. The difference in outcome of pregnancy may be due to an unfavourable circumstances related to work and some nutritional problems rather than to the actual work. Therefore, it is recommended to improve working conditions, facilities, nutrition and regulations related to work