Oral misoprostol may be useful in less-developed countries as it is equally effective in minimising blood loss in the third stage of labour and for reducing postpartum haemorrhage but easier to use than standard oxytocics

2001 ◽  
Vol 5 (2) ◽  
pp. 49-50 ◽  
Author(s):  
Daniel V. Surbek
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Developed Countries ◽  
Less Developed Countries ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage

scholarly journals POSTPARTUM HAEMORRHAGE

2015 ◽  
Vol 22 (06) ◽  
pp. 793-797
Author(s):  
Faiqa Saleem Baig ◽  
Nadeem Shahzad ◽  
Hafiza Naveeda Khurshid ◽  
Aisha Malik
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Controlled Trial ◽  
Significant Risk ◽  
Developed Countries ◽  
Active Management ◽  
Preventive Strategy ◽  
Third Stage ◽  
Group A ◽  
Group B

The most common complication 0f the third stage of labour is postpartumhaemorrhage, which remains a leading cause of maternal mortality (25.0%), especially indeveloping countries. In developed countries, 3-5% of deliveries are complicated by postpartumhaemorrhage: in developing countries, it is 50 times more common .Third stage of labourwhich exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage andpuerperal infection. The best preventive strategy for these complications is active managementof third stage of labour. Active management includes administration of oxytocin within oneminute of birth of baby. Objectives: To compare the mean blood loss after administration ofintra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active managementof third stage of labour. Study Design: Randomized controlled trial. Period: Six months from1-1-2013 to 30-06-2013. Setting: Department of Obstetrics and Gynaecology, Unit-III JinnahHospital Lahore. Methodology: 100 patients fulfilling selection criteria were included in thestudy from labour room. These patients were randomly divided into two groups by usinglottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml ofnormal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocinintravenous stat at anterior shoulder. Total blood loss was noted after complete delivery ofplacenta. Results: Mean age was 25.0±3.9 and 24.4±3.5 in group-A and B, respectively. Meangestational age was 38.20±0.96 weeks in group-A and 38.40±0.94 weeks in group-B. Meanblood loss in intraumbilical oxytocin group was 311.20±27.23 ml and in intravenous oxytocingroup mean blood loss was 373.60±66.47 ml. There was statistically significant differencebetween two groups (p<0.001). In group-A 15 patients (30.0%) and in group-B 20 patients(40.0%) were primigravida while remaining patients were multigravida. Conclusion: The usageof intraumbilical oxytocin in active management of third stage of labour is beneficial in reducingthe blood loss in third stage and thus helps in preventing postpartum haemorrhage.

scholarly journals Active Management of the Third Stage of Labour: A Brief Review and Update

2020 ◽  
Vol 33 (2) ◽  
pp. 149-156
Author(s):  
Nahid Sultana ◽  
Ferdousi Begum ◽  
Shahana Shermin
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
Evidence Based ◽  
Mortality And Morbidity ◽  
The Third ◽  
Third Stage ◽  
Maternal Mortality And Morbidity ◽  
And Training ◽  
Uterine Fundus

Blood loss due to postpartum haemorrhage (PPH) and its complications constitute one ofthe major causes of maternal mortality and morbidity. Active management of third stage oflabour (AMTSL) plays an immense role in preventing maternal death due PPH. But till dateobstetricians all over the world and the concerned international bodies could not reach to asingle agreement about its universal use. This approach is practiced widely in many centresand there are some specific guidelines regarding its practical use. AMTSL as a prophylacticintervention and is composed of a package of three components or steps: 1) administrationof a uterotonic, preferably oxytocin, immediately after birth of the baby; 2) controlled cordtraction (CCT) to deliver the placenta; and 3) massage of the uterine fundus after the placentais delivered. In 2012, the results of a large WHO-directed, multi-centred clinical trial showedthat the most important AMTSL component was the administration of an uterotonic, theother two steps contributes relatively less in blood loss. But WHO recommends to continueall three steps of AMTSL for management and training of third stage of labour. This article isa brief review of the recent guidelines and evidence based practice of active management ofthe third stage of labour. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 149-156

scholarly journals Active management of third stage of labour: a comparative study of intra-umbilical oxytocin versus intramuscular oxytocin

2017 ◽  
Vol 6 (8) ◽  
pp. 3434
Author(s):  
Neerja Gupta ◽  
Manjushree Athokpam
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Developed Countries ◽  
Active Management ◽  
Singleton Pregnancy ◽  
Third Stage ◽  
Maternal Morbidity And Mortality ◽  
Group 2 ◽  
Volume Difference ◽  
Group 1

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality, not only in the developing countries but also in developed countries. Every 4 minutes one woman dies from pregnancy or child birth related complications. The present study is to compare oxytocin used via intra-umbilical or intramuscular route in the active management of third stage of labour with respect to duration and amount of bleeding.Methods: Four hundred pregnant women at term of a singleton pregnancy with spontaneous onset of labour were included in the study and were randomly divided into 2 groups of 200 women each. Group 1, intra-umbilical oxytocin 10U diluted in 10ml of saline, and Group 2, intramuscular oxytocin 10U were given after the delivery of baby.Results: The outcome criteria with respect to third stage of labour were: duration of the 3rd stage of labour, blood loss by volume, difference in haemoglobin. A significant reduction in duration of third stage (p = 0.001) and blood loss in third stage (p =0.0001) in intra-umbilical oxytocin group was found when compared with intramuscular oxytocin use.Conclusions: Intra-umbilical oxytocin is better alternative to intramuscular oxytocin in active management of third stage of labour.

scholarly journals Comparison of Oral Misoprostol with Intravenous Oxtocin in the In the Management of the Third Stage of Labour: A Randomized Controlled Trial

2021 ◽  
Vol 8 (09) ◽  
Author(s):  
Ifeanyi Onyekpa ◽  
Odugu BU ◽  
Onah LN ◽  
Okafor II
Keyword(s):  
Developing Countries ◽  
Statistical Analysis ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
The Third ◽  
Cord Clamping ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Third Stage ◽  
Labour Ward

Background: Postpartum haemorrhage (PPH) is defined as the loss of 500ml of blood or more from the vagina following vaginal birth or 1000ml following caesarean delivery. The third stage of labour is the period between the delivery of the baby and the delivery of the placenta and membranes and its management is central to the prevention of postpartum haemorrhage (PPH). There are basically two methods of managing the third stage of labour namely active and physiological/expectant. The active management includes the use of uterotonic drugs immediately following delivery of the fetus, early cord clamping and cutting, and controlled umbilical cord traction. The active management of the third stage of labour with oxytocin has been found to reduce the risk of primary PPH significantly; however, the problem of inadequate supply of electricity, high cost and paucity of skilled manpower to administer it has negatively affected its use in developing countries and has made the search for a more suitable alternative expedient. Misoprostol on the other hand has been found to have good uterotonic activities, affordable and stable at room temperature; making its use in the resource-poor countries a veritable alternative. Aims: To determine if there is any difference in the efficacy of intravenous oxytocin over oral misoprostol in the management of the third stage of labour Study Design: This was a prospective, double-blinded, randomized trial of uncomplicated pregnant women who had vaginal delivery in the labour ward of the ESUT Teaching Hospital, Enugu. Sample Size: Two hundred (200) pregnant women who satisfied the inclusion criteria were recruited into the study with each arm accommodating 100 participants. Methodology: The eligible women were recruited on presentation to the labour ward after giving their consent. They were randomly allocated into 2 groups: A and B. Group A received 2 tablets (400µg) of oral misoprostol and 1mililtre(ml) of sterile water intravenously while group B  received 2 tablets of white vitamin c and 1ml (10iu) of intravenous oxytocin immediately after cord clamping and cutting following the delivery of the baby. The patient was observed for significant clinical vaginal bleeding or PPH. For the purposes of this study, any bleeding/PPH accompanied with a greater than 30% rise in baseline pulse rate qualified for transfusion. A proforma was used to record the necessary data Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software version 20.0 for Windows. Statistical analysis was both descriptive and inferential at 95% confidence level. The socio-demographic variables were used to categorize the data and this was subjected to comparative statistical evaluation to yield frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P<0.05 at one degree of freedom (df=1) was considered statistically significant. Results and Conclusion: There was no significant difference in the number of women that received blood transfusion, the amount of blood transfused and the need for additional oxytocics on both arms of the study. However, there was a significant difference in the occurrence of side-effects with shivering and vomiting being prominent in the misoprostol and oxytocin arms respectively. Conclusion: There was no difference in the efficacy of oxytocin over misoprostol in the management of the 3rd stage of labour. We therefore, recommend that misoprostol can be adopted as an alternative/substitute to oxytocin in the management of the third stage of labour especially in developing countries.

A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour

2001 ◽  
Vol 16 (1) ◽  
pp. 31-35 ◽  
Author(s):  
P.S. Ng ◽  
A.S.M. Chan ◽  
W.K. Sin ◽  
L.C.H. Tang ◽  
K.B. Cheung ◽  
...  
Keyword(s):  
Postpartum Haemorrhage ◽  
Controlled Trial ◽  
Haemoglobin Concentration ◽  
Singleton Pregnancy ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Misoprostol Group ◽  
Orally Active ◽  
To Receive

Abstract Postpartum haemorrhage accounts for nearly 28% of maternal mortality in developing countries. Syntometrine is an effective and commonly used oxytocic in preventing postpartum haemorrhage, but it requires a controlled storage environment and i.m. administration. Misoprostol is an orally active uterotonic agent. A total of 2058 patients having a singleton pregnancy, low risk for postpartum haemorrhage and vaginal delivery were randomized to receive either 1 ml syntometrine or 600 μg misoprostol for the management of the third stage of labour. There were no significant differences between the two groups in the mean blood loss, the incidence of postpartum haemorrhage and the fall in haemoglobin concentration. The need for additional oxytocic injection was significantly higher in the misoprostol group [relative risk (RR) 1.62, 95% confidence interval (CI) 1.34–1.96], but that of manual removal of placenta was reduced (RR 0.29, 95% CI 0.09–0.87). Shivering and transient pyrexia were more common in the misoprostol group. Oral misoprostol might be used in the management of the third stage, especially in situations where the use of syntometrine is contraindicated and facilities for storage and parenteral administration of oxytocics are limited.

scholarly journals Randomized Comparison of Oral Misoprostol and Oxytocin in the Third Stage of Labour

Journal SOGC ◽  
2001 ◽  
Vol 23 (11) ◽  
pp. 1083-1089
Author(s):  
Krisztina I. Bajzak ◽  
Joan M.G. Crane ◽  
Donna R. Hutchens ◽  
Robert L. Walley ◽  
David C. Young
Keyword(s):  
The Third ◽  
Oral Misoprostol ◽  
Third Stage

Double blind RCT of early versus traditional oxytocin management in the third stage to prevent blood loss

2004 ◽  
Vol 191 (6) ◽  
pp. S69 ◽  
Author(s):  
Albert Schaefer ◽  
Laura Klein ◽  
Pam Wolfe ◽  
Gretchen Heindricks ◽  
Lance Downs ◽  
...  
Keyword(s):  
Blood Loss ◽  
Double Blind ◽  
The Third ◽  
Third Stage

Active management of the third stageof labor for the prevention of postpartum haemorrhage

2014 ◽  
Vol 63 (2) ◽  
pp. 22-27
Author(s):  
Natalya Vladimirovna Artymuk ◽  
Mariya Nikolayevna Surina ◽  
Tatyana Yuryevna Marochko ◽  
Natalya Borisovna Kolesnikova
Keyword(s):  
Blood Loss ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
Controlled Study ◽  
The Third ◽  
Randomized Controlled ◽  
Obstetric Haemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Perinatal Center

Obstetric haemorrhage remains a main cause of maternal morbidity and mortality. A hospital-based, individually randomized controlled study was proposed. 1095 women delivering vaginally in Kemerovo Perinatal Center were examined. Absence of controlled cord tractions hasn’t significant effect on amount of blood loss in the III stage, and frequency of PPH, in usage of additional uterotonics, postpartum hemoglobin levels, frequency of manual removal of placenta.

Association of the Length of the Third Stage of Labor and Blood Loss Following Vaginal Delivery

2018 ◽  
Vol 111 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Nader Z. Rabie ◽  
Songthip Ounpraseuth ◽  
Dawn Hughes ◽  
Patrick Lang ◽  
Micah Wiegel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vaginal Delivery ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage
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