Arunarani, R (2009) Active management of third stage of labour with IV Methergine, IM oxytocin and transrectal misoprostol - A Comparative study. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: PostPartum Hemorrhage (PPH) is a nightmare even to the present day obstetrician as it is sudden, often unpredictable and the consequences may be catastrophic. The introduction of oxytocics in the prevention and management of PPH, has contributed to the reduction in maternal mortality rate (Moir 1955).1 PPH is the leading cause of matemal deaths in the developing world, responsible for 25 percent of all global deaths. Thus worldwide 125,000 women die due to Postpartum Hemorrhage. The primary aim in the management of PPH should be its prevention. Hence any means of reducing the blood loss in the third stage without considerable side effect is always welcome. Uterine atony remains the most common cause of postpartum hemorrhage. A review of major causes in postpartum bleeding pointed out uterine atony as the aetiology in 81% of PPH cases (Anjaneyulu et al., 1988). 2 Hence adequate contraction and retraction of uterus is essential for the prevention of Post Partum Hemorrhage. Routine administration of oxytocics reduce the risk of postpartum hemorrhage by 40% (prendivilli et al 1988).3 The drugs commonly used in the active management of third stage of labour are 1. Oxytocin 2, Methyl ergometrine 3. 15 methyl PGF2α 4. Misoprostol. AIM OF THE STUDY: To evaluate and compare IV Methergine, IM Oxytocin and Transrectal Misoprostol in the Active Management of Third Stage of Labour, with regard to the: i) Duration of third stage of labour. ii) Blood loss during the third stage of labour. iii) Occurence of side effects of the drugs. MATERIALS AND METHODS: 300 patients were included in the study. 100 patients were allotted IV Methergine (0.2 mg) during anterior shoulder delivery under Group I. 100 patients were allotted I.M Oxytocin 10U after delivery of the baby under Group II. 100 patients were allotted Transrectal Misoprostol 600 mcg after delivery of the baby under Group III. Study period - (May 2008 –August 2008). INCLUSION CRITERIA - 1) age 20-35yr, 2) >37 wks of gestation, 3) Singleton pregnancy, 4) Vertex presentation, 5) No fetal distress on admission. EXCLUSION CRITERIA - 1) Previous caesarean section, 2) Multiple pregnancy, 3) Breech presentation, 4) Multipara > 5, 5) Intrauterine fetal death, 6) Previous scarred uterus ( mymectomy / hysterotomy), 7) Cardiac / Renal/ Hepatic/ Epileptic/ Severe PIH/ Severe Anemia. METHOD: Procedure of drug administration Group I - Inj Methergine 0.2mg was given intravenously during the delivery of the anterior shoulder of the baby. Group II - Inj Oxytocin 10IU im given after the delivery of the baby within a minute. Group III- T.Misoprostol 600mcg kept transrectally immediately after the delivery of the baby. CONCLUSION: Predicting who will have PPH based on risk factors is difficult, because two third of women who developed PPH have no risk factors. Therefore all women should be considered as at risk for PPH and Hemorrhage prevention must be incorporated into the care provided during every labour. Every woman is at risk for PPH. Routine screening to prevent and treat anaemia during pre– conception, antenatal and postpartum period. Counsel women on nutrition, focusing on available iron and folic acid rich foods and provide iron and folate supplements during pregnancy. Active management of third stage of labour should be made as a routine for each & every labour conducted in an institution. There is need for a Randomized controlled trial of active versus expectant management of the third stage of labour in different clinical settings such as in domiciliary practice in the developing world, where the risk of maternal mortality associated with the third stage of labour is very high. When ergometrine is used as a compoment of active management, it is associated with an increase risk of retained placenta & unpleasant side effects like nausea, vomiting and hypertension and has limitations in its use. Oxytocin is the first line of choice for prevention of PPH because it is more heat & light stable, as effective as or even more effective than ergot alkoids or prostaglandins and has fewer side effects & infact no side effect was noted in this study. Misoprostol may be used when other oxytocic agents are not available for the prevention of PPH; it is cost effective, heat & light stable, in tablet form and easy to use, that can control PPH even without a medically trained attendant.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Active management ; third stage of labour ; IV Methergine ; IM oxytocin ; transrectal misoprostol ; Comparative study. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 08 Dec 2017 02:14 |
| Last Modified: | 08 Dec 2017 02:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4279 |
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