Randomised controlled trial of sublingual and rectal misoprostol in the prevention of primary postpartum haemorrhage in a resource-limited community
JO Awoleke, BT Adeyanju, A Adeniyi… - The Journal of Obstetrics …, 2020 - Springer
The Journal of Obstetrics and Gynecology of India, 2020•Springer
Abstract Background/Purpose Misoprostol is beneficial in preventing postpartum
haemorrhage (PPH). However, there is no consensus yet as to which route will give the
balance of efficacy, safety and patient preference, especially at the recommended dose of
600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual
misoprostol for the prevention of PPH. Methods In a prospective fashion, consenting eligible
parturients were randomised into two groups to receive either 600 mcg of misoprostol …
haemorrhage (PPH). However, there is no consensus yet as to which route will give the
balance of efficacy, safety and patient preference, especially at the recommended dose of
600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual
misoprostol for the prevention of PPH. Methods In a prospective fashion, consenting eligible
parturients were randomised into two groups to receive either 600 mcg of misoprostol …
Background/Purpose
Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH.
Methods
In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24 h postpartum. Primary outcomes were blood loss of 500 ml or greater and at least 10% change in peripartum haematocrit levels.
Results
Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route.
Conclusion
At the recommended dose, sublingually administered misoprostol (‘the sweet of life’) is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol.
ClinicalTrials.gov identifier PACTR201911500348367.
Springer
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