title: Rectal misoprostol versus intramuscular oxytocin for prevention of post partum hemorrhage.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries.,Compared to expectant management, active management decreases the incidence of PPH.
  
  
  OBJECTIVE
  To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the prevention of postpartum hemorrhage.
  
  
  METHODS
  This is a prospective, randomized and analytical study from 1 st September 2009 to 28th February 2010 at Department of Obstetrics and Gynecology, Dhulkhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal. A total of 200 women were included to receive either 1000 micrograms rectal misoprostol tablets or 10 units of oxytocin intramuscularly. Primary outcome measures were the incidence of postpartum hemorrhage or a change in hematocrit or hemoglobin from admission to day two post delivery. Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were noted. Also the side effects of both misoprostol and oxytocin were recorded.
  
  
  RESULTS
  The frequency of postpartum hemorrhage was 4% in the misoprostol subjects and 6% in the control subjects (P=0.886) There were no significant difference among the groups in the drop of hematocrit (P>0.05). Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were similar in both groups. Similarly, the side effects between the misoprostol and oxytocin group within 6 hours was statistically significant (p=0.003) whereas the side effects within 24 hours was statistically not significant (p=0.106).
  
  
  CONCLUSIONS
  Rectal misoprostol is as effective as intravenous oxytocin in preventing postpartum hemorrhage with the similar incidence of side effects and is worthwhile to be used as a uterotonic agent for the routine management of third stage of labor.
authors.affiliation: Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavre, Nepal. phuche_001@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Shrestha
authors.forename: A
authors.initials: A
authors.lastname: Dongol
authors.forename: C D
authors.initials: CD
authors.lastname: Chawla
authors.forename: R K
authors.initials: RK
authors.lastname: Adhikari
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007273:Injections, Intramuscular; D007743:Labor, Obstetric / Q000187:drug effects; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin