School of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool, UK.
BJOG. 2011 Mar;118(4):466-73. doi: 10.1111/j.1471-0528.2010.02821.x. Epub 2010 Dec 24.
To compare the postpartum uterine activity and side effects of various doses of sublingual misoprostol and intramuscular oxytocin.
Single centre, randomised trial.
Zliten Teaching Hospital in Libya.
Forty-nine women who did not receive oxytocics in labour and who delivered vaginally.
Thirty-five women were randomised to receive 200, 400 or 600 mcg of sublingual misoprostol PPH prophylaxis immediately following delivery. These were compared with 14 consecutive women given 10 IU of intramuscular oxytocin. Immediately after placental delivery, a Koala intra uterine pressure catheter was inserted transcervically into the uterine cavity.
Main outcomes measures are the uterine pressure (in Montevideo units) measured over 120 minutes. Other outcomes included temperature and measured blood loss.
Women's age, parity, gestational age and neonatal birth weight were not significantly different between the four groups. There was no difference in intrauterine pressure between the three misoprostol doses. However, the uterine pressure was significantly lower than oxytocin with all three doses for the first 10 minutes (P < 0.008) and significantly higher than oxytocin from 50 to 120 minutes (P < 0.008). A dose-related rise in the body temperature and chills was observed in the misoprostol groups, with 8.3%, 8.3% and 45% of women experiencing a fever >39 °C with the 200, 400, and 600 mcg doses respectively.
Intramuscular oxytocin has the highest immediate post partum uterine activity. Lower doses of misoprostol may be as effective as high doses and with fewer side effects. Clinical outcomes with low-dose misoprostol should be further explored (ISRCTN97277056).
比较不同剂量舌下米索前列醇和肌肉注射催产素对产后子宫活动和副作用的影响。
单中心、随机试验。
利比亚兹利坦教学医院。
49 名未在分娩时使用催产素且经阴道分娩的妇女。
35 名妇女随机接受 200、400 或 600 mcg 舌下米索前列醇 PPH 预防措施，立即在分娩后使用。将这些与 14 名连续接受 10 IU 肌肉注射催产素的妇女进行比较。胎盘娩出后，立即经宫颈将 Koala 宫内压力导管插入子宫腔。
主要观察指标为 120 分钟内测量的子宫压力（以蒙得维的亚单位表示）。其他结果包括体温和测量的失血量。
四组妇女的年龄、产次、胎龄和新生儿出生体重无显著差异。三种剂量的米索前列醇之间的宫内压力无差异。然而，在最初的 10 分钟内，与催产素相比，三种剂量的米索前列醇的子宫压力均显著降低（P < 0.008），从 50 分钟到 120 分钟，与催产素相比，子宫压力均显著升高（P < 0.008）。米索前列醇组观察到体温和寒战呈剂量相关性升高，分别有 8.3%、8.3%和 45%的妇女出现体温>39°C 的发热。
肌肉注射催产素具有最强的产后即刻子宫活动。低剂量米索前列醇可能与高剂量一样有效，且副作用更少。应进一步探讨低剂量米索前列醇的临床效果（ISRCTN97277056）。
