Background: In developing countries, postpartum hemorrhage is responsible for 30% of maternal deaths. Although the World Health Organization recommends the use of oxytocin for the prevention of postpartum hemorrhage, ...Background: In developing countries, postpartum hemorrhage is responsible for 30% of maternal deaths. Although the World Health Organization recommends the use of oxytocin for the prevention of postpartum hemorrhage, the use of misoprostol is increasingly common. The objective of this study was to determine the frequency of postpartum hemorrhage in parturients delivering at Saint-Vincent Hospital and to compare the effectiveness of misoprostol use versus oxytocin in preventing postpartum hemorrhage. Material and Methods: We conducted a comparative longitudinal study at the Saint Vincent Hospital comparing 10 units of intramuscular oxytocin with 600 micrograms of sublingual misoprostol. The study was conducted from 01 January 2017 to 31 December 2019, a period of 3 years. The study population consisted of 2161 consenting women. Of these, 1289 received 10 IU of intramuscular oxytocin and 872 received 600 micrograms of misoprostol. The collected data were entered using Microsoft Excel 2013 and analysed using SPSS version 21 software. Results: The frequency of administration of Misoprostol and oxytocin in parturients was 40.4% and 59.6% respectively in this study. One hundred and fourteen cases of postpartum hemorrhage (114/2161 or 5.3%) were noted among the parturients. The average age of parturients who received oxytocin was 24.36 ± 4.45 years vs 24.63 ± 5.11 years among parturients who received Misoprostol;(p = 0.190). The mean parity was 2.52 ± 1.46 vs 2.66 ± 1.44;(p = 0.020). We noted a high proportion (78.3%) of postpartum hemorrhage from the oxytocin group vs. 21.7% from the Misoprostol group (OR 2.5-fold), with a statistically significant difference (p 0.001). We noted high proportions of uterine atony (92.3%) from the oxytocin group vs 7.7% from the Misoprostol group (p = 0.004). Uterine atony was the actual factor associated with postpartum hemorrhage (OR = 10.0895% CI: 1.78 - 57.10;p = 0.009). Conclusion: Misoprostol 600 Microgram administered sublingually immediately after neonatal expulsion and before delivery was 2.5 times more effective than oxytocin 10 IU/IM. Misoprostol is therefore a good alternative to oxytocin and offers more advantages in management, use and outcome than oxytocin.展开更多
The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour....The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour. A total of 1865 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as prophylaxis for postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after during which oral interviews were conducted and clinical notes studied. The oxytocin medication group exhibited higher abdominal pains (7.1% versus 0.0%;p 0.05) difference in patients acceptability of injectable oxytocin (99.3%) and oral misoprostol (98.3%). Oxytocin usage in the prevention of PPH was associated with abdominal pains and headache while misoprostol was associated with shivering and fever. Patients from this study have demonstrated high level of acceptability of both parenteral oxytocin and oral misopristol prevention of post-partum haemorrhage.展开更多
Objective: To assess the efficiency and tolerance of misoprostol versus oxytocin in Active Management of the Third Period of Childbirth. Framework and Method of Study: The study was carried out at the Porto-Novo unive...Objective: To assess the efficiency and tolerance of misoprostol versus oxytocin in Active Management of the Third Period of Childbirth. Framework and Method of Study: The study was carried out at the Porto-Novo university maternity in Benin. The hospital is level 3. He acted in a randomized clinical trial with a descriptive and comparative aim referred from 1st January 2017 to 31st December 2017. We included all eligible women in labor in the delivery room during the study period and at that gestational age was greater than or equal to 37 weeks of amenorrhea, delivery was done through vaginal birth and delivered with a live birth and agreed to participate in the study. The cases eligible by order of admission were grouped in blocks of two, “Misoprostol” and “Oxytocin” corresponding to the Active Management of the Third Period of delivery. The data collected were captured and analyzed using the SPSS version 20 software. For the comparison of the results, we used the chi-square statistical test and the difference was assumed to be statistically significant for a p ≤ 0.05. The confidentiality of parturient was respected. Results: we recorded 1234 of which were delivered via vaginal birth. The Active Management of the Third Period of Delivery was carried out in 1202 parturients. According to our inclusion criteria, 892 parturients were retained for the study, of which 446 for each group. The average age of parturients was 26.94 ± 5.65 years. Almost pregnancies were mono-fetal (95.7% vs. 93.5%). The average time to expel the placenta after utero-tonic administration was 4.05 ± 0.27 min in the “Misoprostol” group versus 3.82 ± 0.52 min in the “Oxytocin” group (p > 0.05). We had only 9 cases of placental retention in the group “Misoprostol” versus 5 cases in the “Oxytocin” group. Most of the parturients had blood loss less than 500 ml (96.2% vs. 96.6%). The frequency of delivery hemorrhage was 3.8% in the “Misoprostol” group versus 3.4% in the “Oxytocin” group. The mean blood volume lost was 284.33l ± 13.31 ml in the “Misoprostol” group versus 225.94 ± 21.52 ml in the “oxytocin” group. Maternal prognosis was generally good in both groups. Conclusion: Misoprostol may be an alternative in Active Management of the Third Period of Delivery especially in developing countries where the cold chain is often lacking.展开更多
Cesarean birth rates are greater than 20% in many developed countries. The main diagnoses contributing to the high rate of cesarean births in nulliparous women are dystocia and prolonged labor. Traditionally, a policy...Cesarean birth rates are greater than 20% in many developed countries. The main diagnoses contributing to the high rate of cesarean births in nulliparous women are dystocia and prolonged labor. Traditionally, a policy of vaginal dinoprostone for the treatment of unripe cervix or early amniotomy with oxytocin administration for a ripened cervix has been associated with a modest reduction in the rate of cesarean births due to arrest disorders. However, the course of vaginal dinoprostone is tedious and oxytocin should be administered through an infusion pump, which may be inconvenient in certain settings. Because misoprostol has powerful uterotropic and uterotonic effects, and has become a common agent used in the practice of obstetrics and gynecology, the United States Food and Drug Administration removed the absolute contraindication of the drug during pregnancy from its label in April 2002. However, excessive uterine contractility resulting in tachysystole or fetal distress is always a concern with the oral or vaginal use of fixeddosage misoprostol. Therefore, misoprostol should be administered with caution to ensure that fetal hypoxia does not occur. A pilot trial examining the use of very small, frequent, titrated oral misoprostol dosages administered every 2 h was fi rst conducted by Hofmeyr et al in 2001. Given women's different metabolisms and responses tomisoprostol, another method of titrating individualized oral misoprostol with dosing administered every hour relative to uterine response was then developed by Cheng in 2006. Based on previous studies, this titration method is potentially an ideal alternative to traditional dinoprostone, oxytocin or the previously established misoprostol dosing method for labor induction or augmentation.展开更多
Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesare...Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesarean rate, compared to spontaneous onset deliveries. On the other hand, mortality and morbidity in cesareans are higher. The most common pharmacological drugs used for induction are prostaglandins: dinoprostone and misoprostol. The “gold standard” for labour induction is vaginal misoprostol. The oral route is also effective and also has several benefits like faster onset and easear administration. In recent years several publications state that the administration of misoprostol oral solution, given in doses gradually, is associated with a lower cesarean and hyperstimulation rate than the cases where vaginal misoprostol has been used in pregnant women with unripe cervix. Furthermore, being its half life shorter, it may be very useful in case of uterine hyperstimulation and, probably, a high percentage of women prefer this oral administration to the vaginal one. The objective of this study is to compare the efficacy, safety and side effects on mother and fetus on use of oral versus vaginal administration for induction of labour for prolonged gestation (41 weeks) and premature rupture of membranes, both with live fetus. Methods/Design: Design: double blind controlled trial. Study population: Pregnant women whose labour will be induced due to premature rupture of membranes or prolonged gestation. Inclusion Criteria: 1) Bishop Test equal to or less than 7;2) Single pregnancy;3) Pregnancy at term (37 - 42 weeks);4) No history of uterine surgery;5) Cephalic presentation;6) Live fetus;7) No prostaglandins contraindications. Discussion: Nowadays induction rates are very high, ranging from 25% to 30% approximately. In these cases caesarean rates are higher than when the delivery starts spontaneously. That is one of the main reasons why caesareans have increased, mainly in the cases of nuliparous women with immature cervix. If we can prove the hypothetical good results obtained through the use of dosed oral misoprotol, we will be able to reduce the number of induced deliveries by cesarean, and so improve the levels of security for the mother and the foetus, and, as a consequence, provide a higher quality of medical attention to the newborn and the mother.展开更多
文摘Background: In developing countries, postpartum hemorrhage is responsible for 30% of maternal deaths. Although the World Health Organization recommends the use of oxytocin for the prevention of postpartum hemorrhage, the use of misoprostol is increasingly common. The objective of this study was to determine the frequency of postpartum hemorrhage in parturients delivering at Saint-Vincent Hospital and to compare the effectiveness of misoprostol use versus oxytocin in preventing postpartum hemorrhage. Material and Methods: We conducted a comparative longitudinal study at the Saint Vincent Hospital comparing 10 units of intramuscular oxytocin with 600 micrograms of sublingual misoprostol. The study was conducted from 01 January 2017 to 31 December 2019, a period of 3 years. The study population consisted of 2161 consenting women. Of these, 1289 received 10 IU of intramuscular oxytocin and 872 received 600 micrograms of misoprostol. The collected data were entered using Microsoft Excel 2013 and analysed using SPSS version 21 software. Results: The frequency of administration of Misoprostol and oxytocin in parturients was 40.4% and 59.6% respectively in this study. One hundred and fourteen cases of postpartum hemorrhage (114/2161 or 5.3%) were noted among the parturients. The average age of parturients who received oxytocin was 24.36 ± 4.45 years vs 24.63 ± 5.11 years among parturients who received Misoprostol;(p = 0.190). The mean parity was 2.52 ± 1.46 vs 2.66 ± 1.44;(p = 0.020). We noted a high proportion (78.3%) of postpartum hemorrhage from the oxytocin group vs. 21.7% from the Misoprostol group (OR 2.5-fold), with a statistically significant difference (p 0.001). We noted high proportions of uterine atony (92.3%) from the oxytocin group vs 7.7% from the Misoprostol group (p = 0.004). Uterine atony was the actual factor associated with postpartum hemorrhage (OR = 10.0895% CI: 1.78 - 57.10;p = 0.009). Conclusion: Misoprostol 600 Microgram administered sublingually immediately after neonatal expulsion and before delivery was 2.5 times more effective than oxytocin 10 IU/IM. Misoprostol is therefore a good alternative to oxytocin and offers more advantages in management, use and outcome than oxytocin.
文摘The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour. A total of 1865 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as prophylaxis for postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after during which oral interviews were conducted and clinical notes studied. The oxytocin medication group exhibited higher abdominal pains (7.1% versus 0.0%;p 0.05) difference in patients acceptability of injectable oxytocin (99.3%) and oral misoprostol (98.3%). Oxytocin usage in the prevention of PPH was associated with abdominal pains and headache while misoprostol was associated with shivering and fever. Patients from this study have demonstrated high level of acceptability of both parenteral oxytocin and oral misopristol prevention of post-partum haemorrhage.
文摘Objective: To assess the efficiency and tolerance of misoprostol versus oxytocin in Active Management of the Third Period of Childbirth. Framework and Method of Study: The study was carried out at the Porto-Novo university maternity in Benin. The hospital is level 3. He acted in a randomized clinical trial with a descriptive and comparative aim referred from 1st January 2017 to 31st December 2017. We included all eligible women in labor in the delivery room during the study period and at that gestational age was greater than or equal to 37 weeks of amenorrhea, delivery was done through vaginal birth and delivered with a live birth and agreed to participate in the study. The cases eligible by order of admission were grouped in blocks of two, “Misoprostol” and “Oxytocin” corresponding to the Active Management of the Third Period of delivery. The data collected were captured and analyzed using the SPSS version 20 software. For the comparison of the results, we used the chi-square statistical test and the difference was assumed to be statistically significant for a p ≤ 0.05. The confidentiality of parturient was respected. Results: we recorded 1234 of which were delivered via vaginal birth. The Active Management of the Third Period of Delivery was carried out in 1202 parturients. According to our inclusion criteria, 892 parturients were retained for the study, of which 446 for each group. The average age of parturients was 26.94 ± 5.65 years. Almost pregnancies were mono-fetal (95.7% vs. 93.5%). The average time to expel the placenta after utero-tonic administration was 4.05 ± 0.27 min in the “Misoprostol” group versus 3.82 ± 0.52 min in the “Oxytocin” group (p > 0.05). We had only 9 cases of placental retention in the group “Misoprostol” versus 5 cases in the “Oxytocin” group. Most of the parturients had blood loss less than 500 ml (96.2% vs. 96.6%). The frequency of delivery hemorrhage was 3.8% in the “Misoprostol” group versus 3.4% in the “Oxytocin” group. The mean blood volume lost was 284.33l ± 13.31 ml in the “Misoprostol” group versus 225.94 ± 21.52 ml in the “oxytocin” group. Maternal prognosis was generally good in both groups. Conclusion: Misoprostol may be an alternative in Active Management of the Third Period of Delivery especially in developing countries where the cold chain is often lacking.
文摘Cesarean birth rates are greater than 20% in many developed countries. The main diagnoses contributing to the high rate of cesarean births in nulliparous women are dystocia and prolonged labor. Traditionally, a policy of vaginal dinoprostone for the treatment of unripe cervix or early amniotomy with oxytocin administration for a ripened cervix has been associated with a modest reduction in the rate of cesarean births due to arrest disorders. However, the course of vaginal dinoprostone is tedious and oxytocin should be administered through an infusion pump, which may be inconvenient in certain settings. Because misoprostol has powerful uterotropic and uterotonic effects, and has become a common agent used in the practice of obstetrics and gynecology, the United States Food and Drug Administration removed the absolute contraindication of the drug during pregnancy from its label in April 2002. However, excessive uterine contractility resulting in tachysystole or fetal distress is always a concern with the oral or vaginal use of fixeddosage misoprostol. Therefore, misoprostol should be administered with caution to ensure that fetal hypoxia does not occur. A pilot trial examining the use of very small, frequent, titrated oral misoprostol dosages administered every 2 h was fi rst conducted by Hofmeyr et al in 2001. Given women's different metabolisms and responses tomisoprostol, another method of titrating individualized oral misoprostol with dosing administered every hour relative to uterine response was then developed by Cheng in 2006. Based on previous studies, this titration method is potentially an ideal alternative to traditional dinoprostone, oxytocin or the previously established misoprostol dosing method for labor induction or augmentation.
文摘Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesarean rate, compared to spontaneous onset deliveries. On the other hand, mortality and morbidity in cesareans are higher. The most common pharmacological drugs used for induction are prostaglandins: dinoprostone and misoprostol. The “gold standard” for labour induction is vaginal misoprostol. The oral route is also effective and also has several benefits like faster onset and easear administration. In recent years several publications state that the administration of misoprostol oral solution, given in doses gradually, is associated with a lower cesarean and hyperstimulation rate than the cases where vaginal misoprostol has been used in pregnant women with unripe cervix. Furthermore, being its half life shorter, it may be very useful in case of uterine hyperstimulation and, probably, a high percentage of women prefer this oral administration to the vaginal one. The objective of this study is to compare the efficacy, safety and side effects on mother and fetus on use of oral versus vaginal administration for induction of labour for prolonged gestation (41 weeks) and premature rupture of membranes, both with live fetus. Methods/Design: Design: double blind controlled trial. Study population: Pregnant women whose labour will be induced due to premature rupture of membranes or prolonged gestation. Inclusion Criteria: 1) Bishop Test equal to or less than 7;2) Single pregnancy;3) Pregnancy at term (37 - 42 weeks);4) No history of uterine surgery;5) Cephalic presentation;6) Live fetus;7) No prostaglandins contraindications. Discussion: Nowadays induction rates are very high, ranging from 25% to 30% approximately. In these cases caesarean rates are higher than when the delivery starts spontaneously. That is one of the main reasons why caesareans have increased, mainly in the cases of nuliparous women with immature cervix. If we can prove the hypothetical good results obtained through the use of dosed oral misoprotol, we will be able to reduce the number of induced deliveries by cesarean, and so improve the levels of security for the mother and the foetus, and, as a consequence, provide a higher quality of medical attention to the newborn and the mother.
