Gohil J T, Tripathi Beenu
J Obstet Gynaecol India. 2011 Aug;61(4):408-12. doi: 10.1007/s13224-011-0060-5. Epub 2011 Sep 23.
The purpose of the study was to compare the efficacy of misoprostol 400 μg per rectally, injection oxytocin 10 IU intramuscular, injection methylergometrine 0.2 mg intravenously and injection (0.5 mg ergometrine + 5 IU oxytocin) intramuscular on reducing blood loss in third stage of labor, duration of third stage of labor, effect on haemoglobin of the patient, need of additional oxytocics or blood transfusion and associated side effects and complications.
A prospective non-randomized uncontrolled study was carried out in the Department of Obstetrics and Gynecology, SSG Hospital and Medical College, Baroda enrolling 200 women and dividing them into four groups. Active management of 3rd stage of labor was done using one of the 4 uterotonics as per the group of the patient. The main outcome measures were the amount of blood loss, the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 h after delivery.
Methylergometrine was found to be superior to rest of the drugs in the study with lowest duration of third stage of labor (P = 0.000096), lowest amount of blood loss (P = 0.000017) and lowest incidence of PPH (P = 0.03). There was no significant difference in the pre-delivery and the post-delivery hemoglobin concentration amongst the four groups with P = 0.061. The need of additional oxytocics and blood transfusion was highest with misoprostol as compared to all other drugs used in the study with P = 0.037 and 0.009, respectively. As regards side effects, misoprostol was associated with shivering and pyrexia in significantly high number of patients as compared to the other drugs used in the study while nausea, vomiting and headache were more associated with methylergometrine and ergometrine-oxytocin. However all the side effects were acceptable and preferable to the excessive blood loss.
Methylergometrine has the best uterotonic drug profile amongst the drugs used, strongly favouring its routine use as oxytocic for active management of third stage of labor. Misoprostol was found to cause a higher blood loss compared to other drugs and hence should be used only in low resource setting where other drugs are not available. The role of misoprostol in third stage of labor needs larger studies to be proved.
本研究旨在比较米索前列醇400μg经直肠给药、缩宫素10IU肌内注射、甲基麦角新碱0.2mg静脉注射以及（0.5mg麦角新碱+5IU缩宫素）肌内注射在减少第三产程失血、缩短第三产程时长、对患者血红蛋白的影响、额外使用宫缩剂或输血需求以及相关副作用和并发症方面的疗效。
在巴罗达SSG医院和医学院妇产科进行了一项前瞻性非随机对照研究，纳入200名女性并将她们分为四组。根据患者所在组，使用四种宫缩剂之一对第三产程进行积极管理。主要观察指标为失血量、产后出血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。
研究发现甲基麦角新碱优于其他药物，第三产程时长最短（P = 0.000096），失血量最少（P = 0.000017），产后出血发生率最低（P = 0.03）。四组患者分娩前和分娩后血红蛋白浓度无显著差异（P = 0.061）。与研究中使用的所有其他药物相比，米索前列醇组额外使用宫缩剂和输血的需求最高，分别为P = 0.037和0.009。在副作用方面，与研究中使用的其他药物相比，米索前列醇导致大量患者出现寒战和发热，而恶心、呕吐和头痛在甲基麦角新碱和麦角新碱-缩宫素组更为常见。然而，所有副作用都是可以接受的，且优于大量失血。
在所用药物中，甲基麦角新碱具有最佳的宫缩药物特性，强烈支持将其作为宫缩剂常规用于第三产程的积极管理。与其他药物相比，米索前列醇导致的失血量更高，因此仅应在无法获得其他药物的资源匮乏地区使用。米索前列醇在第三产程中的作用需要更多研究来证实。
