A Comparative Study Between Rectal Misoprostol and Standard Ecbolic Therapy for Prevention of postpartum Hemorrhage

Abstract

According to evidence based results, routine active management I, was found to be superior to expectant management. Therefore, active II management should be the routine management of choice for women k l expecting to deliver a baby by vaginal delivery in a maternity hospital l Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used

Drugs used for prophylaxis against postpartum hemorrhage include oxytocin (Syntocinon 5 and 10 nJ ampoules, Sandoz), methyl ergometrine maleate (Methergine 0.2 mg ampoule, Sandoz). Randomized trials and their meta-analysis confirmed that these agents can reduce the incidence of postpartum hemorrhage by about 30% to 40% compared with placebo, when given parenterally following delivery of the baby. There are strong suggestions of benefit for oxytocin in terms of postpartum haemorrhage, and the need for therapeutic oxytocics.There seems little evidence in favour of ergot alkaloids alone compared to either oxytocin alone, or to combined oxytocin and methergine (Syntometrine), but the data are sparse.

Misoprostol (Cytotec; Searle, UK; Misotac, Sigma, Egypt) is a prostaglandin E1 synthetic analogue, The only Food and Drug Administration approved indication in misoprostol labeling is the treatment and prevention of intestinal ulcer disease resulting from non­ steroidal antiinflammatory use.This medication is inexpensive, easy to store, and stable at room temperature. It has been shown to be a useful agent for termination of pregnancy in the first, second and third