Harriott J, Christie L, Wynter S, DaCosta V, Fletcher H, Reid M
Department of Obstetrics and Gynaecology, University Hospital of the West Indies, Kingston 7, Jamaica, West Indies.
West Indian Med J. 2009 Jun;58(3):201-6.
a) To compare the clinical effect of rectal misoprostol with intramuscular syntometrine in reducing blood loss in the third stage of labour b) to determine the severity and incidence of side effects of both drugs and c) to measure blood loss, patient tolerance and acceptance of rectal misoprostol.
One hundred and forty parturients were randomly allocated to receive intramuscular syntometrine (syntocinon 10 IU + ergometrine 0.5 mg) or rectal misoprostol 400 microg within five minutes of the delivery of the anterior shoulder Blood loss was measured by the use of a plastic collection drape. Additional oxytocic therapy was instituted for uterine atony or if blood loss was in excess of one litre.
There was no significant difference in patient demographics of each treatment group (Table 1). There was no difference in mean duration of the third stage of labour (8.4 +/- 14 min vs 7.8 +/- 6.6 min). The mean blood loss from those parturients receiving misoprostol (180.1 +/- 120 mls) was not significantly different (p = 0.5) from those receiving syntometrine (197 +/- 176.97 mls) for the active management of the third stage of labour Treatment with syntometrine was associated with a significant elevation of post-partum systolic blood pressure compared with misoprostol treatment (mean increase 0.57 +/- 18.79 mmHg vs -1.43 +/- 14.17 mmHg, (mean +/- SD), p < 0.04). Rectal misoprostol was well tolerated in 88.5% of participants, 11.4% reported that insertion was uncomfortable, of which 2.8% reported that they would have preferred parenteral drug administration.
The clinical effect of rectal misoprostol and intramuscular syntometrine were not different at the doses used in the active management of the third stage of labour in this study. Rectal misoprostol was well tolerated by the patients and had a low side effect profile. Blood loss assessment using the blood collection drape is of invaluable benefit in resource-poor settings.
a）比较直肠用米索前列醇与肌肉注射合成宫缩素在减少第三产程失血方面的临床效果；b）确定两种药物副作用的严重程度和发生率；c）测量直肠用米索前列醇的失血量、患者耐受性和接受度。
140名产妇在胎头前肩娩出后5分钟内被随机分配接受肌肉注射合成宫缩素（缩宫素10国际单位+麦角新碱0.5毫克）或直肠用米索前列醇400微克。使用塑料收集单测量失血量。若出现子宫收缩乏力或失血量超过1升，则采用额外的催产治疗。
各治疗组患者的人口统计学特征无显著差异（表1）。第三产程的平均持续时间无差异（8.4±14分钟对7.8±6.6分钟）。在第三产程的积极处理中，接受米索前列醇的产妇平均失血量（180.1±120毫升）与接受合成宫缩素的产妇（197±176.97毫升）相比无显著差异（p = 0.5）。与米索前列醇治疗相比，合成宫缩素治疗与产后收缩压显著升高相关（平均升高0.57±18.79毫米汞柱对-1.43±14.17毫米汞柱，（平均±标准差），p < 0.04）。88.5%的参与者对直肠用米索前列醇耐受性良好，11.4%报告插入时不舒服，其中2.8%报告更倾向于胃肠外给药。
在本研究中，用于第三产程积极处理的剂量下，直肠用米索前列醇和肌肉注射合成宫缩素的临床效果无差异。患者对直肠用米索前列醇耐受性良好，副作用发生率低。在资源匮乏地区，使用血液收集单评估失血量具有极大的益处。
