A study of prophylactic use of 15-methyl prostalglandin F2alpha in the active management of third stage of labour.

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.

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

Umbilical vein oxytocin in the management of third stage of labour.

The aim of the study was to evaluate the efficacy of intra-umbilical oxytocin in minimizing the blood loss during 3rd and 4th stage of labour. Seventy-five pregnant multigravidas without any obstetric or medical complications were studied. It was found that the expulsion of the placenta was rapid as compared to the group treated with normal saline but not with methylergometrine. The drop in hemoglobin and hematocrit was comparable in patients receiving intra-umbilical oxytocin and those with active management of 3rd stage with methylergometrine.