Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

Abstract

BACKGROUND Postpartum hemorrhage is a very important cause of maternal mortality worldwide. According to WHO, 20 million of morbidities and 33 % of maternal mortality can be attributed to PPH worldwide.  WHO states that misoprostol can also be used to prevent PPH, due to its beneficial effects in low income settings.

OBJECTIVE The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing blood loss with that of methyl ergotamine in first two hours after delivery.

METHODOLOGY It was a randomized controlled, single center, double blind trial of sublingual misoprostol versus intravenous methyl ergotamine for control of blood loss in 82 women with singleton pregnancies at term who underwent delivery at Sir Ganga Ram hospital. Participants were divided randomly into two groups (A and B). Randomization was done by Microsoft Excel 5.0 random number generator. The participants were given either misoprostol 600 micrograms sublingually immediately or injection methyl ergotamine 0.2 mg at time of delivery of anterior shoulder of baby. The outcome measures studied were blood loss, blood transfusions, drop in hemoglobin and side effects of both drugs.

RESULTS Mean age of women in Misoprostol group was 25.76±3.48years. Mean age of methyl ergotamine was 26.0 3.67 years Mean gestational age of women in Misoprostol group was 39.73±1.32 and mean gestational age of women in methyl ergotamine group was 40.09±1.22 weeks. Before delivery mean Hb level was statistically same in both group but post-delivery mean Hb level was significantly dropped in other group. I.e. p-value=0.000165.In Misoprostol group none had blood transfusion while in methyl ergotamine group 4(9.76%) women had blood transfusion but this difference was not statistically significant. Nausea, vomiting and hypertension were significantly higher in methyl ergotamine group. However for pyrexia and shivering an opposite trend was seen for Misoprostol when compared with methyl ergotamine.

CONCLUSION Results of this trial showed that sublingual misoprostol is more effective as compared to intravenous methyl ergotamine. It has many advantages including easy transport, storage and oral route which make it a good uterotonic agent in low-resource areas. It was also associated with lesser side effects