Intrarectal prostaglandin in the management of postpartum hemorrhage

ABSTRACT

To investigate the effectiveness of intrarectal prostaglandin in the management of atonic postpartum hemorrhage in patient who do not respond to conventional oxytocic agents. This study included patients, who had single term pregnancies with cephalic presentation and had normal vaginal deliveries in Gynae Unit-1 from 1st February 1999 to 30th November 1999. All patients had active management of third stage of labour and if uterine response was not adequate, then first uterine massage was done and oxytocic infusion was given. If patient continued to bleed PGE2 vaginal tablet was placed in the rectum. A total of 1200 normal vaginal deliveries occurred during the study period and 51 cases of atonic PPH were reported. Intrarectal PGE2 was used in 19 patients and was effective in 13 patients. In the rest six patients surgical intervention was done. Gynae Unit-1, Department of Obstetrics and Gynaecology Sandeman Provincial Hospital, Quetta. Results: During the study period 51 cases [4.25%] of atonic PPH were reported out of a total of 1200 normal vaginal deliveries. Twenty one [41.17%] patients were between 35 years and 45 years of age. Twenty two [43.1 3%] patients had a parity between P-5 and P-1 0. In 1 9 [37.25%] patients intrarectal PGE2 was used. It was effective in 13 [68.42%] patients and failed in six [31.57%] patients. Out of six patients, bilateral uterine artery ligation was done in four [66.66%] patients and hysterectomy done in two [33.33%] patients