Calişkan Eray, Meydanli M Mutlu, Dilbaz Berna, Aykan Burcu, Sönmezer Meral, Haberal Ali
Social Security Council: Maternity and Women's Health Teaching Hospital, Ballibaba sok. No: 86/3, 06660 Küçükesat, Ankara, Turkey.
Am J Obstet Gynecol. 2002 Oct;187(4):1038-45. doi: 10.1067/mob.2002.126293.
The purpose of this study was to compare misoprostol 600 microg intrarectally with conventional oxytocics in the treatment of third stage of labor.
In a controlled trial, 1606 women were randomly grouped to receive (1) oxytocin 10 IU plus rectal misoprostol, (2) rectal misoprostol, (3) oxytocin 10 IU, and (4) oxytocin 10 IU plus methylergometrine. The main outcome measures were the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 hours after delivery.
The incidence of postpartum hemorrhage was 9.8% in the group that received only rectal misoprostol therapy compared with 3.5% in the group that received oxytocin and methylergometrine therapy (P =.001). There were no significant differences among the 4 groups with regard to a drop in hemoglobin concentrations. Significantly more women needed additional oxytocin in the group that received only rectal misoprostol therapy, when compared with the group that received oxytocin and methylergometrine therapy (8.3% vs 2.2%; P <.001). The primary outcome measures were similar in the group that received only rectal misoprostol therapy and the group that received only oxytocin therapy.
Rectal misoprostol is significantly less effective than oxytocin plus methylergometrine for the prevention of postpartum hemorrhage.
本研究旨在比较直肠给予600微克米索前列醇与传统宫缩剂在处理第三产程中的效果。
在一项对照试验中，1606名妇女被随机分组，分别接受（1）缩宫素10 IU加直肠米索前列醇，（2）直肠米索前列醇，（3）缩宫素10 IU，以及（4）缩宫素10 IU加甲基麦角新碱。主要结局指标为产后出血的发生率以及分娩前至分娩后24小时血红蛋白浓度的下降情况。
仅接受直肠米索前列醇治疗组的产后出血发生率为9.8%，而接受缩宫素和甲基麦角新碱治疗组的产后出血发生率为3.5%（P = 0.001）。在血红蛋白浓度下降方面，4组之间无显著差异。与接受缩宫素和甲基麦角新碱治疗组相比，仅接受直肠米索前列醇治疗组中需要额外使用缩宫素的妇女明显更多（8.3% 对2.2%；P < 0.001）。仅接受直肠米索前列醇治疗组和仅接受缩宫素治疗组的主要结局指标相似。
在预防产后出血方面，直肠米索前列醇的效果明显低于缩宫素加甲基麦角新碱。
