To compare the efficacy and safety of oral misoprostol with IM ergometrine + oxytocin in the management of the third stage of labour.
A Multicentre Randomized Controlled Trial of Oral Misoprostol and IM Ergometrine + Oxytocin in the Management of the Third Stage of Labour
6 Nov, 10
A Multicentre Randomized Controlled Trial of Oral Misoprostol and IM Ergometrine + Oxytocin in the Management of the Third Stage of Labour
Aim
Methods
- A prospective, multicentre, randomized, controlled trial performed from in 3 tertiary training centres in Hong Kong
- Patients having a singleton pregnancy and a vaginal delivery were randomly assigned to receive either
- 600 ?g of oral misoprostol immediately after delivery of the baby; n = 1026 or
- 1 ml of 5 units of oxytocin and 0.5 mg ergometrine IM, at delivery of the anterior shoulder of the baby; n = 1032
- Primary outcome - amount of blood loss during delivery and the occurrence of primary PPH
- Maternal BP, pulse and temperature were recorded immediately after delivery and repeated 30 and 60 min later
Results
- In both groups,
- No significant difference in the amount of estimated blood loss and the incidence of PPH (3500 ml) or severe PPH (31000 ml)
- No significant difference in the incidence of delayed haemorrhage within the first 24h
- Incidence of prolonged third stage (330 min) similar
- In misoprostol group,
- Significantly lower (P <0.05) incidence of manual removal of placenta
- Incidence of hypertension (BP3140/90 mmHg) after delivery significantly (P <0.05) lowered
- Misoprostol does not cause hypertension and is associated with a 55-60% reduction in the incidence of hypertension when compared with IM ergometrine + oxytocin
Conclusion
Misoprostol may be used as an alternative to IM ergometrine + oxytocin in the management of the third stage of labour, especially in situations where IM ergometrine + oxytocin is contraindicated or where storage and parenteral administration of oxytocics is a potential problem.
Hum Reprod. 2001;16(1):31-35
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