The Preventive Effect Of Misoprostol And The Oxytocin In Postpartum Hemorrhage

Background:Postpartum hemorrhage is the main cause of mortality in parturient.The factors contribute to the death of postpartum hemorrhage including the amount and speed of blood-loss, as well as the health condition of the parturient. The mortality and morbidity rates of postpartum hemorrhage are higher in some developing countries due to their low income, unhealthy living style, under-nourishment, and lacking of the self-protection ability of reproductive health. Postpartum hemorrhage is very common in both developing and developed countries. According to the epidemic data in 2005, postpartum hemorrhage is the leading cause in parturient mortality in 31 provinces, cities, and autonomous regions in China. The maternal mortality rate (MMR) is one of the important parameter showing the status of politics, economic, culture, health care in the region, and is also the important indicator measuring the development and improvement of a society.As the serious complication in obstetrics, postpartum hemorrhage will cause the secondary anemia, puerperal infection, and sometimes can even lead to Sheehan's syndrome when bleeding is serious, that will directly influence the living quality of the survival women. When the postpartum hemorrhage could not be controlled effectively, to stop bleeding, the parturient's uterus must be removed through surgery. To develop a fast and efficient measure is the key to lower the mortality rate and improve the living quality of the women after delivery. The main reasons of the postpartum hemorrhage are usually including uterine utony, placenta factor, injury of the soft birth canal and coagulation defects, of which the uterine utony is the most common one, it counts about 70%-80% of the total. Therefore stimulating the uterine contraction is the key to cure uterine utony. As the uterotonic, misoprostal alcohol has the advantage in storage which does not need to be refrigerated, so it is especially suitable for the underdeveloped area. By comparing the effectiveness between Misoprostal and oxytocin in the prevention of postpartum hemorrhage, the study aimed to seek a simple, safe and efficient way to prevent the postpartum hemorrhage.Method:Based on the standard of inclusion and exclusion, Total of 514 parturients fit the criteria of inclusion and exclusion and randomly divided into two groups, Miso group (261 subjects) and oxytocin group (253 subjects). The parturients in Miso group received 400μg of prostate alcohol (2 tablets) via rectum right after baby delivery, and at the meantime they received infusion of 500 ml lactate Linge liquor added 10 ml normal saline. The parturients in oxytocin group received infusion of 500 ml lactate Linge liquor added 20 IU oxytocin, and 400μg of placebo (2 tablets) via rectum at the same time.Results:The case numbers of postpartum hemorrhage were 17 and 12 in Miso group and in oxytocin group respectively. The incidence rate was not significantly different between the two groups (Χ2=0.756, P>0.05).In average, the parturients PCV fell 10% 24 hours after they were delivery,9 were in Miso group and 10 were in another., there was no significant difference (Χ2=0.092, P>0.05).The hemoglobin potency:before delivery, the hemoglobin potency was 10.6±1.2g/dL and 10.7±1.4g/dL in Miso and oxytocin groups respectively, the difference was not significant (U=0.347, P>0.05). Twenty-four hours after delivery, the hemoglobin potency was 9.8±1.4g/dL and 10±1.3g/dL in Miso and oxytocin groups respectively, there was no significant difference between groups (U=0.720, P >0.05).Before and after delivery, both systolic and diastolic pressure were not significantly changed in Miso and oxytocin group (P>0.05)The duration of the third stage of labor was 8.25±2.31 minutes and 7.97±2.82 minutes in Miso and oxytocin groups respectively. The difference was no significant (U=1.115,P>0.05).The case number of receiving blood transfusion was 8 in Miso group and 4 in oxytocin group, there was no significance difference (Χ2=1.241, P>0.05).The symptoms after treatment for the postpartum hemorrhage by miso and oxytocin included shilvering, fever (≥38℃), regurgitation, vomitting and diarrhea. More cases were found in miso group, especially for shilvering (Χ2=88.588, P<0.05) and fever. (Χ2=45.319, P<0.05). However, the symptoms disappeared in a short time without special treatment.Conclusion:Applying 400μg misoprostol in rectum could reach similar effectiveness as 20 IU oxytocin via vein infusion in the prevention of postpartum hemorrhage. The former even has the advantages in low cost and more convenient in application. We suggest to apply it in the third stage of labor to prevent postpartum hemorrhage especially in the underdeveloped area for cutting down medical expense and simplifying the procedure. Since present study was carried out in a high level hospital and only in one hospital, the sample size was not very large, the reliability of the result should be further verified in a large scale investigation and multiple levels of hospital. If the effectiveness of misoprostol in postpartum hemorrhage could be further confirmed, it could be considered as a routine method in prevention of postpartum hemorrhage. By this way, part of medical care cost will be reduced.