Sublingual administration of misoprostol for treatment of postpartum hemorrhage

ABSTRACT

To examine the effectiveness and safety of high-dose sublingual misoprostol for treatment of postpartum hemorrhage compared to methylergometrine by means of a double blind randomized clinical trial. After active management of third stage of labor, 94 women with atonic postpartum hemorrhage were randomized between misoprostol treatment [4 x 200 ug sublingual and IV saline] or four placebo tablets and IV 0.25 mg methylergometrine injection. The primary outcome variable was the measured blood loss >/= 500 ml in one hour after enrolment. The significance level was chosen at P < .05. The measured blood loss > 500 ml in one hour after enrollment was not significantly different between misoprostol and ergometrine groups [p = 0.77]. Other estimations of blood loss showed no significant differences between the groups, though, more patients in misoprostol group needed additional uterotonics to stop their bleeding [27 [57.45%] vs. 16 [34.04%], p = .04]. With misoprostol side-effects were increased, namely shivering and pyrexia > 38.5°C [p = .01]. compared with methylergometrine, misoprostol provides nearly equal effect against postpartum hemorrhage but associated with more side effects and more demands of additional uterotonics