Postpartum hemorrhage; comparison of efficacy of ergometrine with misoprostol in prophylaxis in cesarean section

ABSTRACT

Worldwide PPH remains one of the most common cause of maternal mortality and is largely preventable maternal deaths mainly in low income countries. 80% of it occurs due to uterine atony and uterotonics can decrease the risk of uterine atony. Misoprostol has powerful uterotonic effect because it is well absorbed and has potential to be used more widely than would be possible with injectable uterotonics alone. The objective of this study is to compare efficacy of misoprostol with ergometrine in cesarean delivery for management of PPH. Randomized controlled trial. The duration of study was six months from 1/1/2010 to 30th/6/2010. Department of Gynae and obstetrics, DHQ hospital, Faisalabad. All patients fulfilling inclusion criteria were included in study and before cesarean section Hb was carried out and Patients were divided into two groups, GP[1], and GP[2]. GP[1] was given 800 ug MP per rectal just before starting cesarean Section and GP[2] was given intravenous ergometrine at delivery of head or anterior 2 shoulder. Blood loss was measured objectively after delivery of the baby with help of standard size kidney tray of 500cc and post operative Hb was Carried out on 3rd post operative day. 187 Patients were randomly allocated in GP[1] and GP[2] each. In GP[1], misoprostol was given 800 microg per rectal just before starting cesarean section and 13 patients [7%] out of 187 have blood loss more than 500ml measured by standard size kidney tray while in GP[2] intravenous ergometrine was given at delivery of the head and in this group 25 patients [13.5%] out of 187 had 2 blood loss more than 500ml, so misoprostol was found to be a better uterotonic than ergometrine for prevention of PPH. On the third post operative day Hb was carried out and in GP[1] 13 patients [7%] out of 187 had their Hb less than 9 g/dl while in GP[2] 25 patients [13.5%] had Hb less than 9 g/d1. Mp is stable, cost effective and easily administrable drug and was found to be comparatively more powerful uterotonic than ergometrine for preventing uterine atony