COMPARISON OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN FOR  REDUCING MEAN BLOOD LOSS AFTER VAGINAL DELIVERY

MA KHAN; M PARVEEN; S SADIQ; RM UMAIR; S KAINAT

doi:10.54112/bcsrj.v2022i1.153

Authors

MA KHAN Department of Gynecology, Nishtar Medical University & Hospital Multan-Pakistan
M PARVEEN Department of Gynecology, Nishtar Medical University & Hospital Multan-Pakistan
S SADIQ Department of Gynecology, Nishtar Medical University & Hospital Multan-Pakistan
RM UMAIR Department of Gynecology, Nishtar Medical University & Hospital Multan-Pakistan
S KAINAT Department of Gynecology, Nishtar Medical University & Hospital Multan-Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2022i1.153

Keywords:

Postpartum hemorrhage, maternal morbidity, oxytocin, misoprostol

Abstract

Postpartum hemorrhage (PPH) is significantly associated with maternal morbidity and mortality, and many maternal deaths are preventable. Uterine atony is managed through uterotonic agents like prostaglandin F2 alpha (PGF2a), misoprostol, ergometrine and oxytocin and uterine rubbing. This prospective study was designed to compare the role of sublingual misoprostol and IV oxytocin in preventing blood loss after vaginal deliveries. This study was conducted at the Department of Obstetrics & Gynecology, Nishtar Hospital Multan, from 15 February 2021 to 14 August 2021. The study was conducted on 60 patients, 30 in both groups, who were selected through consecutive nonprobability sampling. Subjects were divided into Group A and Group B. 600 µg misoprostol (3 doses of 200 µg) was administered to Group A. 5 IU oxytocin was administered to Group B, with 3.3 IU/min at the beginning with the interval of 20 minutes until regular contractions are achieved. A maximum of 30mU/min oxytocin was infused. Mean blood loss was measured and recorded in proforma. The mean age of the subjects was 29.21 ± 6.07 years. The mean age of Group A was 29.40 ± 5.85 years, while that of Group B was 29.21 ± 6.32 years. Mean PPH blood loss in Group A, and B was 118.97 ± 20.26 ml and 154.13 ± 15.21 ml (P = 0.0001). The mean postpartum blood loss was higher by intravenous oxytocin than by sublingual misoprostol.

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References

Alejandra, G. C. L., Angel, R. Z. M., and Lisbeth, K. G. J. (2021). Postpartum Hemorrhage: Risk Factors and Preventive Strategies. Journal of Gynecology and Obstetrics9, 200-205.

Atukunda, E. C., Siedner, M. J., Obua, C., Mugyenyi, G. R., Twagirumukiza, M., and Agaba, A. G. (2014). Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in Uganda: a double-blind randomized non-inferiority trial. PLoS medicine11, e1001752.

Aziz, S., Kazi, S., Haq, G., and Soomro, N. (2014). Oral misoprostol versus oxytocin in the management of third stage of labour. J Pak Med Assoc64, 428-432.

Bilgin, Z., and Kömürcü, N. (2019). Comparison of the effects and side effects of misoprostol and oxytocin in the postpartum period: A systematic review. Taiwanese Journal of Obstetrics and Gynecology58, 748-756.

Bláha, J., and Bartošová, T. (2022). Epidemiology and Definition of PPH Worldwide. Best Practice & Research Clinical Anaesthesiology.

Boltman-Binkowski, H. (2018). A systematic review of best practices in the acute management of postpartum haemorrhage in primary maternity care settings.

Diaz, V., Abalos, E., and Carroli, G. (2018). Methods for blood loss estimation after vaginal birth. Cochrane Database of Systematic Reviews.

Hancock, A., Weeks, A. D., and Tina, L. D. (2019). Assessing blood loss in clinical practice. Best Practice & Research Clinical Obstetrics & Gynaecology61, 28-40.

Koch, D. M., and Rattmann, Y. D. (2019). Use of misoprostol in the treatment of postpartum hemorrhage: a pharmacoepidemiological approach. Einstein (São Paulo)18.

Lohano, R., Haq, G., Kazi, S., and Sheikh, S. (2016). Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc66, 22-6.

Maged, A. M., Wali, A. A., Metwally, A. A., and Salah, N. (2022). The efficacy of misoprostol in reducing intraoperative blood loss in women undergoing elective cesarean section. A systematic review and meta‐analysis. Journal of Obstetrics and Gynaecology Research48, 2038-2070.

Morfaw, F., Miregwa, B., Bi, A., Mbuagbaw, L., Anderson, L. N., and Thabane, L. (2021). Comparing and combining evidence of treatment effects in randomized and nonrandomized studies on the use of misoprostol to prevent postpartum hemorrhage. Journal of Evidence‐Based Medicine14, 198-207.

Naeem, M., Latif, M., Nawaz, F., Latif, M., and Aftab, S. (2021). Compare the Sublingual and Per Rectal Routes of Misoprostol Administration in Third Stage of Labor in Terms of Average Blood Loss. Drug Resistant TB and Bone Marrow Stem Cells32, 105.

Othman, E. R., Fayez, M. F., Abd El Aal, D. E. M., Mohamed, H. S. E.-D., Abbas, A. M., and Ali, M. K. (2016). Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: a randomized clinical trial. Taiwanese Journal of Obstetrics and Gynecology55, 791-795.

Ottun, T. A., Adewunmi, A. A., Rabiu, A. K., Olumodeji, A. M., Oladipo, O. M., and Olalere, H. F. (2022). Misoprostol and oxytocin versus oxytocin alone in the active management of the third stage of labour: a randomised, double-blind, placebo-controlled trial. Journal of Obstetrics and Gynaecology42, 1048-1053.

Rabie, N. Z., Ounpraseuth, S., Hughes, D., Lang, P., Wiegel, M., and Magann, E. F. (2018). Association of the Length of the Third Stage of Labor and Blood Loss Following Vaginal Delivery. Southern medical journal111, 178-182.

Rasri, W. (2018). Intrauterine misoprostol plus intravenous oxytocin for reduction of blood loss in cesarean delivery. Thai Journal of Obstetrics and Gynaecology, 237-245.

Shaheen, N., and Khalil, S. (2019). Safety and efficacy of 600 ug sublingual Misoprostol versus 10 U intramuscular Oxytocin for management of third stage of labor. Rawal Medical Journal44, 137-137.

Valiani, M., Allameh, Z., Bahadoran, P., and Amani, E. (2018). A Study on the Combined Effect of Vaginal Misoprostol and Venous Oxytocin on Induction of Labor, Bishop Score, and Duration of Labor. Journal of Isfahan Medical School36, 954-963.

Zeng, Y., Zhang, Y., Zhen, M., Lao, L., Ma, Y., Liu, L., Fan, D., and Ai, W. (2022). Side-effects of oxytocin in postpartum hemorrhage: a systematic review and meta-analysis. American journal of translational research14, 1934.