Priya G Prema, Veena P, Chaturvedula Latha, Subitha L
Department of Obstetrics and Gynecology, JIPMER, Pondicherry, India.
, DII-11, JIPMER Quarters, Dhanvantari nagar, Pondicherry, 605006, India.
Arch Gynecol Obstet. 2015 Dec;292(6):1231-7. doi: 10.1007/s00404-015-3763-5. Epub 2015 May 20.
In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage.
This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted.
The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group.
Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.
在印度，三分之二的孕产妇死亡发生在农村地区，那里缺乏交通设施，缺乏储存诸如催产素等注射用子宫收缩剂的冷藏设备，缺乏专业人员进行药物注射，且缺乏无菌注射器和针头。因此，本研究旨在评估米索前列醇作为一种安全、有效、易于给药的非肠道用药在预防产后出血方面的效果。
本研究于2012年8月至2014年7月期间进行。足月单胎妊娠、因阴道分娩入院的低风险女性符合研究条件。总共500名女性被随机分为两组，每组250名，分别在胎肩娩出时舌下含服400微克米索前列醇或肌肉注射10单位催产素。记录患者因素、分娩参数、失血量和副作用。
两组女性在年龄、产次、孕周和分娩参数方面匹配良好。两组之间的失血量有统计学意义（p = 0.04）。米索前列醇组平均失血量为70毫升，催产素组为75毫升。颤抖是米索前列醇组有统计学意义的副作用（p = 0.004），恶心是催产素组有统计学意义的副作用（p = 0.003）。
在预防产后出血的第三产程积极处理中，舌下含服米索前列醇作为预防性宫缩剂与肌肉注射催产素效果相当。
