Parsons Steven M, Walley Robert L, Crane Joan M G, Matthews Kay, Hutchens Donna
Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's NL.
Matercare International, St. John's NL.
J Obstet Gynaecol Can. 2006 Jan;28(1):20-26. doi: 10.1016/S1701-2163(16)32029-1.
To compare the effects of oral misoprostol 800 mug with intramuscular oxytocin 10 IU in routine management of the third stage of labour.
This randomized controlled trial was performed in a rural district hospital in Ghana, West Africa, and enrolled women in labour with anticipated vaginal delivery and no known medical contraindication to prostaglandin administration. Women were randomized to receive oral misoprostol 800 mug or intramuscular oxytocin 10 IU. Blood samples were taken to determine hemoglobin concentration before delivery and at 12 hours post partum. Treatment was administered at delivery of the anterior shoulder. The primary outcome was the change in hemoglobin concentration from before to after delivery. Secondary outcomes included other measures of blood loss and presumed medication side effects.
In total, 450 women were enrolled in the study. Their baseline characteristics were similar. There was no significant difference between the groups in the change in hemoglobin concentration (misoprostol 1.07 g/dL and oxytocin 1.00 g/dL). The only significant secondary outcomes were shivering (80.7% with misoprostol vs. 3.6% with oxytocin) and pyrexia (11.4% with misoprostol, none with oxytocin).
Routine use of oral misoprostol 800 microg appears to be as effective as 10 IU parenteral oxytocin in minimizing blood loss during the third stage of labour, as determined by change in hemoglobin concentration. Misoprostol appears to be a safe, inexpensive, and effective uterotonic for use in rural and remote areas, where intravenous oxytocin may be unavailable.
比较口服800微克米索前列醇与肌内注射10国际单位缩宫素在第三产程常规管理中的效果。
这项随机对照试验在西非加纳的一家农村地区医院进行，纳入预计经阴道分娩且无已知前列腺素给药医学禁忌的分娩妇女。将妇女随机分为接受口服800微克米索前列醇或肌内注射10国际单位缩宫素两组。在分娩前和产后12小时采集血样以测定血红蛋白浓度。在前肩娩出时进行治疗。主要结局是分娩前后血红蛋白浓度的变化。次要结局包括其他失血指标和假定的药物副作用。
总共450名妇女纳入研究。她们的基线特征相似。两组之间血红蛋白浓度的变化无显著差异（米索前列醇组为1.07克/分升，缩宫素组为1.00克/分升）。唯一显著的次要结局是寒战（米索前列醇组为80.7%，缩宫素组为3.6%）和发热（米索前列醇组为11.4%，缩宫素组无）。
根据血红蛋白浓度变化判断，常规使用800微克口服米索前列醇在减少第三产程失血方面似乎与10国际单位肠外缩宫素一样有效。米索前列醇似乎是一种安全、廉价且有效的宫缩剂，适用于可能无法获得静脉缩宫素的农村和偏远地区。
