Role of oral misoprostol, rectal misoprostol and intramuscular 15-methyl-PGF2α for prophylaxis of postpartum haemorrhage

Background: Postpartum haemorrhage (PPH) is the most common cause of maternal mortality. Approximately 28% of maternal deaths worldwide are due to haemorrhage, mostly in the postpartum period. The WHO estimates that of the 303,000 maternal deaths occurring every year, 45,000 takes place in India, where two third of maternal deaths occur after delivery, PPH being the most common cause of death (29.6%). This study compared oral misoprostol, rectal misoprostol and intramuscular 15methyl-PGF2α for prophylaxis of postpartum haemorrhage in terms of various outcomes such as drop in Hb concentration after delivery, the amount of blood loss during delivery and duration of third stage of labour.Methods: Randomized comparative trial in 1:1:1 ratio of oral misoprostol, rectal misoprostol and IM 15methyl-PGF2α groups of 300 low risk pregnant women (with singleton pregnancy and ≥28 weeks gestation age) who underwent normal vaginal delivery at Kasturba hospital during 1 year period.Results: The mean blood loss was significantly less in IM 15methyl-PGF2α group as compared to oral and rectal misoprostol groups. Incidence of PPH was least in IM 15methyl-PGF2α group as compared to oral and rectal misoprostol groups but the difference observed was not statistically significant. Maximum cases with Hb drop > 1 gm/dl were present in the rectal misoprostol group.Conclusions: IM 15methyl-PGF2α was found to be most effective and rectal misoprostol was found to be least effective for prophylaxis of PPH. Gastrointestinal side effects like nausea, vomiting and diarrhoea were significantly higher in the IM 15methyl-PGF2α group, however it had much lower incidence of shivering and pyrexia