Role of Intaumbilical Misoprostol in Prevention of Postpartum Hemorrhage

Abstract

Background: Prostaglandins have mainly been used for postpartum hemorrhage(pph) when other measures fail,misoprostol, a new and inexpensive prostaglandin E1analougue,has been suggested as an alternative for routine management of he thirdstage of labour.Aim o the study: To determine the efficacy of intraumbilical oxytocin administrationcompared with intraumbilical misoprostol administration for prevention of postpartumhemorrhage.Materials and methods: Prospective study done at Babylon Hospital for Maternityand Pediatrics from February 2009 to September 2009.study involved 75 women in their 3rd. stage of labor subdivided into 3 groups 25 foreach received either 30 i.u oxytocin in 30 ml saline or 800 mcg of misoprostoldissolved in 30 ml of saline 3rd group was control received only 30 ml of salineinjected into the placental bed via umbilical vein using pipingas technique .The primary outcome measured was duration of 3rd stage of labor , amount of bloodloss and need for manual removal of placenta. P-value of <0.01 consideredstatistically significant.Results: All groups are comparable in their demographic criteria. Intraumbilicalinjection of misoprostol associated with shorter duration of 3rd stage of labor (2.5 ±0.2 min) compared with oxytocin group (3.5 ± 1.1 min) and control group (5.56 ± 2.2min) p value <0.0001. Blood loss was comparable in both misoprostol and oxytocingroup (31.6± 15 ml and 33.2±18.7 ml respectively, p-value >0.05) which wassignificantly lower than control group (147.1 ± 99 ml) p value <0.0001. No reportedcases of retained placenta in both oxytocin and misoprostol groups compared with 2cases (8%) in control group. Further uterotonic drugs required in 20% of controlgroup. No significant side effects reported in all study groups.Conclusion:1- Intaumbilical injection of 800 mcg misoprostol dissolved in 30 ml of saline usingpipingas technique was more effective than intraumbilical oxytocin in shortening theduration of 3rd stage of labor and both reduce the incidence of postpartumhemorrhage.2- the intraumbilical injection of uterotonics is non- invasive ,effective and clinicallysafe method for management of 3rd stage of labor and prevention of postpartumhemorrhage.