Oral misoprostol as effective as oxytocin injection for treating postpartum bleeding.(Clinical report)

QUEBEC CITY -- Oral misoprostol appears to be as effective as oxytocin by injection in reducing blood loss at delivery, but is associated with an increased need for additional oxytocic drugs, according to a randomized, controlled trial presented in poster format at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada.

"Oral misoprostol may be used to reduce postpartum bleeding, particularly in areas where injectable oxytocic drugs are unavailable," reported lead investigator Thomas Baskett, M.B., professor of obstetrics and gynecology at Dalhousie University in Halifax, Nova Scotia.

The synthetic PGE1 analogue has the advantage of being a cheap, stable, and orally administered uterotonic agent. "The main application for this is in developing countries, where they don't have personnel looking after women who can inject, or where there is no equipment or oxytocics to do so," he said in an interview, adding that it might also have applications in rural communities if injectable oxytocics were not available.

Misoprostol has a role as second-line therapy if other injectables fail. "You might not use it routinely for active management of the third stage to reduce or prevent blood loss, but if bleeding occurs, then you can give misoprostol either orally or rectally with ease, and it's easy to have it stored in nursing stations or hospitals," he said.

To assess efficacy of both agents, he and his colleagues compared 311 women given 400 mcg of oral misoprostol and 311 women who were given intravenous oxytocin, 5 units given after delivery of the anterior shoulder of the fetus. Researchers looked at women who had cephalic presentation and delivered vaginally, between 2000 and 2003 at the IWK Health Centre in Halifax. Those who had a multiple pregnancy, placenta previa, abruptio placentae, ...