Vimala N, Mittal S, Kumar S, Dadhwal V, Mehta S
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Int J Gynaecol Obstet. 2004 Oct;87(1):1-5. doi: 10.1016/j.ijgo.2004.05.016.
To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor.
One hundred twenty low risk pregnant women at term with spontaneous onset of labor were included in the study. The women were randomized to receive either two tablets of misoprostol (200 microg/tablet) sublingually or 1 ml of methylergometrine (200 microg) intravenous injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were: need for additional oxytocic drugs, blood loss >or=500 ml, change in hemoglobin levels and side effects.
Postpartum hemorrhage as defined by hemorrhage >or=500 ml occurred in 3.1% of the women in the sublingual misoprostol group but none of the women in the methylergometrine group (P > 0.05). There was a need for additional oxytocic drugs in 5.0% and 8.3% after methylergometrine and misoprostol, respectively (P > 0.05). The change in hemoglobin levels at 24 h postpartum were 0.8 and 0.7 gm% in methylergometrine and misoprostol group, respectively(P > 0.05). In the misoprostol group, 6.6% women developed fever >or=38 degrees C and 21.6% had shivering while in methylergometrine group none experienced these side effects. However, the incidence of other side effects like nausea, vomiting, headache and giddiness were similar in both groups.
Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.
比较舌下含服米索前列醇与静脉注射甲基麦角新碱对第三产程进行积极管理的疗效及副作用。
本研究纳入120例足月、自然发动分娩的低风险孕妇。在胎儿前肩娩出后，将这些孕妇随机分为两组，一组舌下含服两片米索前列醇（每片200微克），另一组静脉注射1毫升甲基麦角新碱（200微克）。主要观察指标包括：是否需要追加宫缩剂、失血量≥500毫升、血红蛋白水平变化及副作用。
舌下含服米索前列醇组有3.1%的妇女发生了定义为失血量≥500毫升的产后出血，而甲基麦角新碱组无一人发生（P>0.05）。甲基麦角新碱组和米索前列醇组分别有5.0%和8.3%的患者需要追加宫缩剂（P>0.05）。产后24小时，甲基麦角新碱组和米索前列醇组血红蛋白水平变化分别为0.8克%和0.7克%（P>0.05）。米索前列醇组有6.6%的妇女体温≥38℃，21.6%的妇女出现寒战，而甲基麦角新碱组无这些副作用。然而，两组恶心、呕吐、头痛和头晕等其他副作用的发生率相似。
舌下含服米索前列醇在预防产后出血方面似乎与静脉注射甲基麦角新碱同样有效。然而，需要更大规模的随机研究来支持其常规使用。
