Comparative study of Efficacy of Intravenous Methyl Ergometrine with Rectal Misoprostol in the Prevention of PPH in at Risk PPH Mothers

Vanitha, M (2006) Comparative study of Efficacy of Intravenous Methyl Ergometrine with Rectal Misoprostol in the Prevention of PPH in at Risk PPH Mothers. Masters thesis, Madras Medical College, Chennai.


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This present prospective study “Comparative study of efficacy of rectal misoprostol versus intravenous methylergometrine in the prevention of PPH in at risk PPH mothers” was carried out at Govt. Kasturba Gandhi Hospital Madras Medical College, Chennai during the period October 2004 – August 2005. Total of hundred cases who had any of the risk factors for PPH were included in the study. Group I - Included fifty patients in whom intravenous methyl ergometrine was administered following delivery of anterior shoulder. Group II - Included fifty patients in whom, 800 mcg of misoprostol was kept rectally following delivery of the anterior shoulders. The efficacy of prophylactic intravenous methyl ergometrine, and rectal misroprostal in reducing the postpartum blood loss were compared in terms of duration of third stage, amount of blood loss, need for additional oxytocic therapy and change in prenatal and postnatal hemoglobin level in gm % and the results were statistically analyzed. Observations of this study includes, • Most of the patients were in the age group of 20-30 years. • 99% of cases were booked and most of the patients were belonged to class V socio-economic status. • 42% of cases were second gravida 33% of cases were primigravida and 3 case were grand multipara. • 54% of cases had overdistended uterus and 37% of cases had prolonged labor as the risk factor for PPH. • 70% of cases had spontaneous onset of labor and in remaining 30% of cases labor was induced with either ARM & oxytocin, PGE2 gel alone or PGE2 with oxytocin. • 47% of patients were delivered by labor natural with episiotomy or perineal laceration of IIo. 11% of cases had operative vaginal delivery either vacuum extraction or forceps delivery in whom traumatic PPH had been ruled out. • The duration of third stage in 90% of cases in control group was less than 4minutes , and only in 50% of cases in study group it was less than 4 minutes . • The difference in the mean duration of third stage of labor between the two group was 1.25 minutes . • 56% of cases in control group had blood loss of lessthan 200ml. Only 12% of cases in study group had blood loss of lessthan200ml. 70% of cases in study group had blood loss of 200 - 400ml. • Prolonged labor is associated with significantly increased blood loss, when compared to other risk factors. • The difference in mean blood loss between the two groups was 74ml. Comparing the absolute blood loss, parenteral methyl ergometrine appears to be more effective than rectal misoprostol in reducing postpartum blood loss. • Incidence of PPH was 8% in study group as compared to only 4% in control group. • 12% cases in study and 4% cases in control group required additional parenteral oxytocic drugs. • The major side effects noted in study group were pyrexia (14%) and shivering (20%) • Common side effect noted in control group was increase in blood pressure. (16%) • Hemoglobin difference of less than 1gm% was noted in 92% of cases in control group and 84% of cases in study group. • Mean hemoglobin difference between control and study group was 0.31gm%, which has no statistical significance. CONCLUSION: Active management of third stage of labor should be the routine management of choice for women expecting to deliver a baby by vaginal route in a maternity hospital. • Rectal misoprostol is less effective than intravenous methyl ergometrine as part of the active management of third stage of labor for prevention of postpartum hemorrhage . • Misoprostol need not replace oxytocin or ergometrine for prophylaxis in hospitals where these drugs could be properly stored. • Misoprostol is a very valuable drug in the armamentarium of doctors in rural setting and especially midwives, who work in the periphery in developing countries, where these parenteral drugs could not be stored at the desired temperature and where parenteral drugs are impractical to administer or simply not available. • In above situations, misoprostol which is inexpensive, thermo stable with good safety profile will have clear advantages over other conventional injectable oxytocics like methyl ergometrine . • This drug can be safely administered even by paramedical personnel while referring a mother with PPH to higher institutions. • So, misoprostol deserves a special place in every pharmacy, health post and midwifery list and has considerable potential to reduce the maternal mortality from postpartum hemorrhage in developing countries. So, in countries with high maternal mortality and limited resources, introducing low cost, evidence based practices that prevent PPH is an important way to improve women’s health.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Comparative study ; Efficacy ; Intravenous Methyl Ergometrine ; Rectal Misoprostol ; Prevention ; PPH ; Risk PPH Mothers.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 09:53
Last Modified: 05 Dec 2017 01:32

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