|
Discussion
In developing countries postpartum haemorrhage is regarded as one
of the major causes of maternal mortality and morbidity. Consequently,
the active management of the third stage of labour should be practiced
along with the routine use of intravenous oxytocin. To substitute
for oxytocin and to prevent postpartum haemorrhage misoprostol was
chosen because it has similar advantages but with minimal side effects,
low shelf life.
The rectal route has been chosen because of the ease of administration,
and can avoid the gastrointestinal side effects of nausea, vomiting,
and diarrhoea, so it can be given to a nauseated women. The results
of our study met the our expectations where the blood loss did not
exceed the incidence in our hospital ~7% where we use the routine
method of active management of third stage of labour along with oxytocin
intravenously.
Recent studies has shown that rectal misoprostol is useful in the
treatment of third stage of labour and may be effective in the treatment
of postpartum haemorrhage (11-13)
Karkanis et al. studied 240 women who randomly received 400 micrograms
rectal misoprostol after delivery of the infant or parenteral oxytocin5
units intravenously or 10 units intramuscularly) with the delivery
of the anterior shoulder. No difference in Hb was observed between
the groups. The duration of the third stage of labour did not differ
between the two groups.(13)
|
|
In a trial done by Bugalh et al.,
663 women with uncomplicated vaginal delivery were randomised to receive
400 micrograms rectal misoprostol or oxytocin 10 IU IM after delivery
of he infant. No significant differences were observed between groups,
before and 72 hours after delivery. He concluded that rectal misoprostol
appears to be effective as parenteral oxytocin in preventing postpartum
haemorrhage.(10)
Bamigboye et al. (12) in his search for an effective, easily stored,
affordable uterotonic agent to prevent postpartum haemorrhage, underwent
a trial where he randomised 491 women to receive either 400 micrograms
rectal misoprostol (241 women) or one ampule of syntometrin (250 women).
His results showed that he incidence of postpartum hemorrhge, duration
of third stage of labour and the drop in Hb were similar.
Rectal misoprostol in one tablet was used by Shoja et al. (13) to
stop severe delivery induced haemorrhage on uterine atony after failure
of syntocinon. In all the five patients studied haemorrhage ceased
in less than 5 minutes with no immediate side effects observed. This
finding suggests that rectal misoprostol might be used for the control
of severe postpartum haemorrhage, which failed to cease by the ordinary
uterotonic agents.
 
|