Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Int J Gynaecol Obstet. 2012 Nov;119(2):159-62. doi: 10.1016/j.ijgo.2012.05.033. Epub 2012 Aug 25.
To determine whether rectally administered misoprostol can induce intestinal motility compared with oxytocin infusion when used to prevent primary postpartum hemorrhage after cesarean delivery.
In a prospective randomized double-blind study in Nigeria, 218 parturients undergoing cesarean delivery who had risk factors for primary postpartum hemorrhage were enrolled between July 1, 2010, and March 31, 2011. Participants received 600 μg of rectal misoprostol or 20 intravenous units of oxytocin for 4 hours after surgery. The primary outcome was time until passage of flatus. Adverse effects, need for additional analgesic, and length of hospital stay were also assessed.
The misoprostol group had a significantly shorter mean postoperative interval to passage of flatus (20.27 ± 7.77 hours versus 38.34 ± 10.98 hours; P<0.001) and commencement of regular diet (21.08 ± 7.69 hours versus 39.13 ± 10.94 hours; P<0.001). Gastrointestinal adverse effects were more frequent, albeit not significantly, in the misoprostol group: nausea, 6.4% versus 1.8%; vomiting, 7.3% versus 2.8%; and abdominal distension, 3.7% versus 2.8%. The need for additional analgesic was the same in the 2 groups.
After cesarean delivery, rectal misoprostol had the added benefit of inducing intestinal motility. Misoprostol might be considered in a clinical setting where postoperative ileus is anticipated.
比较剖宫产术后使用直肠米索前列醇与催产素预防原发性产后出血时对肠动力的影响。
本前瞻性随机双盲研究于 2010 年 7 月 1 日至 2011 年 3 月 31 日在尼日利亚进行，纳入 218 例有原发性产后出血风险的剖宫产产妇。术后 4 小时内，产妇分别给予 600μg直肠米索前列醇或 20 个单位静脉催产素。主要结局是肛门排气时间。还评估了不良反应、需要额外镇痛药物以及住院时间。
米索前列醇组术后肛门排气时间（20.27±7.77 小时比 38.34±10.98 小时；P<0.001）和开始常规饮食时间（21.08±7.69 小时比 39.13±10.94 小时；P<0.001）明显缩短。米索前列醇组胃肠道不良反应虽不显著但更常见：恶心 6.4%比 1.8%；呕吐 7.3%比 2.8%；腹胀 3.7%比 2.8%。两组需要额外镇痛药物的情况相同。
与催产素相比，剖宫产术后直肠给予米索前列醇可促进肠动力。在预计术后发生肠麻痹的情况下，米索前列醇可在临床中考虑使用。
