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

ABSTRACT

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