%0 Journal Article
%T Safety and Efficacy of Misoprostol versus Oxytocin for the Prevention of Postpartum Hemorrhage
%A Minoo Rajaei
%A Samieh Karimi
%A Zohreh Shahboodaghi
%A Hamidreza Mahboobi
%A Tahereh Khorgoei
%A Farzam Rajaei
%J Journal of Pregnancy
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/713879
%X Postpartum hemorrhage (PPH) is the commonest cause of maternal death worldwide. Studies suggest that the use of misoprostol may be beneficial in clinical settings where oxytocin is unavailable. The aim of this study was to compare the safety and efficacy of oxytocin and misoprostol when used in the prevention of PPH. In a double-blind randomized controlled trial, 400 pregnant women who had a vaginal delivery were assigned into two groups: to receive either 20 IU of oxytocin in 1000£¿mL Ringer¡¯s solution and two placebo tablets or 400£¿mcg oral misoprostol (as two tablets) and 2£¿mL normal saline in 1000£¿mL Ringer¡¯s solution. The quantity of blood loss was higher in the oxytocin group in comparison to the misoprostol group. There was no significant difference in the decrease in hematocrit and hemoglobin between the two groups. Although there was no significant difference in the need for transfusions between the two groups, the patients in the oxytocin group had greater need for additional oxytocin. Results from this study indicate that it may be considered as an alternative for oxytocin in low resource clinical settings. This study is registered with ClinicalTrials.gov NCT01863706. 1. Background Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after caesarean section (CS) or normal vaginal delivery (NVD). It may be defined as ¡Ý500£¿mL hemorrhage after vaginal or ¡Ý1000£¿mL hemorrhage after CS delivery [1¨C3]. PPH is one of the most common obstetric maternal complications and is among the three most common etiologies of maternal death worldwide [4]. Its incidence is increasing and it affects 1¨C5% of all deliveries [5, 6]. Atony is the main cause of PPH and is responsible for about 80% of PPHs [7]. Therefore, uterotonic agents are administered. Oxytocin infusion, single dose of methylergometrine, and then carboprost tromethamine are used in 15-to-20-minute intervals in atony. Misoprostol, which is a prostaglandin E1 analog, is an inexpensive drug and can be absorbed by the following routes of administration: vaginal, rectal, or oral (sublingual or buccal absorption) [8, 9]. Gastrointestinal symptoms (nausea, vomiting, and diarrhea) and fever are the most common adverse effects of misoprostol, which often are mild and self-limited [10¨C12]. Several studies have shown that misoprostol is more effective than oxytocin and methylergometrine in the treatment of PPH [13, 14]. Although misoprostol can be used as first-line therapy in the treatment of PPH where oxytocin is not available [15], other studies have not confirmed that
%U http://www.hindawi.com/journals/jp/2014/713879/