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The Preventive Effect of Misoprostol and the Oxytocin in Postpartum Hemorrhage

Author: GaoZhan
Tutor: YuZengLi
School: Zhengzhou University
Course: Public Health
Keywords: Misoprostol Oxytocin Postpartum hemorrhage Prevention Rectum
CLC: R714.461
Type: Master's thesis
Year: 2010
Downloads: 65
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Abstract

Background: Postpartum bleeding (postpartum heamorrhage, PPH) is the leading cause of maternal mortality, and risk factors of postpartum haemorrhage lies not only in the amount of blood loss and blood loss speed, but also in maternal health. Because of poverty, unhealthy lifestyle, malnutrition, lack of reproductive health, the ability to protect themselves, even more serious in developing countries, postpartum haemorrhage, but so far can not be solved. Postpartum hemorrhage, the most serious consequences of maternal deaths, both developing and developed countries, postpartum hemorrhage are the primary factor in maternal deaths. 2005, 31 provinces, municipalities, autonomous regions and maternal mortality statistics show that postpartum hemorrhage is still the first factor of maternal mortality. The maternal mortality rate (maternal mortality rate MMR) is one of the important parameters to reflect a regional political, economic, cultural, health care, maternal and child health, but also the international community to measure an important indicator of social development and progress, but also reflect the mother-to-child secure an important parameter. Postpartum hemorrhage as serious obstetric complications, probably secondary to iron deficiency anemia, puerperal infection, can cause serious Sheehan's syndrome, a direct impact on the quality of life of women survivors; rapid and massive blood loss can be caused by hemorrhagic shock, endangering maternal life. When postpartum hemorrhage has not been effectively controlled, and ultimately may be necessary for the purpose of resection maternal uterus to achieve hemostasis. Therefore, in-depth study of postpartum hemorrhage, the key to the development of strict and effective prevention and treatment measures is to reduce the maternal mortality rate in China to protect the quality of life of our maternal. The main reason for postpartum hemorrhage uterine atony, placenta, soft birth canal injury and coagulation dysfunction. Caused by uterine atony is the most common, accounting for 70% -90% of the total number of postpartum hemorrhage. To stimulate and strengthen contractions is the key to the treatment of uterine inertia. Misoprostol tablets as a uterotonics, the advantages without refrigeration, easy to store, and is particularly suitable for use in areas of economic backwardness, lack of medical resources. This study through the analysis and comparison of transrectal application of 400 micrograms of misoprostol with intravenous injection of 20 international units of oxytocin to prevent postpartum hemorrhage, in order to find a simple, safe and effective way to reduce the incidence of postpartum hemorrhage. Methods: 514 pregnant women selected according to the inclusion and exclusion criteria, were randomly divided into two groups, namely the misoprostol group (261 people) and the oxytocin group (253). Misoprostol group of pregnant women after childbirth to receive 400 micrograms of misoprostol (2) rectally, intravenously with 10 ml of normal saline 500 ml Ringer lactate solution; oxytocin group received intravenous infusion plus There are 20 international units of oxytocin in 500 ml Ringer lactate solution, rectal placebo 2. Results: The two groups of pregnant women within 24 hours of delivery to measure its results 1. Primary efficacy endpoint proportion of postpartum hemorrhage after childbirth: misoprostol group (17/261), oxytocin group (12/253), χ2 = 0.756 P gt; 0.05 difference was not statistically significant. The secondary efficacy endpoint (1) 24 hours postpartum maternal hematocrit values ??decline ≥ 10%: 9 misoprostol group, the oxytocin group 10, χ2 = 0.092, P gt; 0.05 difference was not statistically significant. (2) 24 hours postpartum hemoglobin: hemoglobin before delivery misoprostol group 10.6 ± 1.2 g / dL, and-oxytocin group 10.7 ± 1.4 g / dL, U = 0.347, P gt; 0.05 difference was not statistically significant; hemoglobin misoprostol after delivery oxytocin group 9.8 ± 1.4g/dL, 10 ± 1.3 g / dL, and U = 0.720, P gt; 0.05 difference was not statistically significant. (3) changes in systolic and diastolic blood pressure: before delivery, systolic blood pressure the the misoprostol group 124 ± 20.9mmHg oxytocin group the 127 ± 19.5mmHg, U = 3.035, P gt; 0.05 difference was not statistically significant; systolic blood pressure meters after childbirth cable group 116 ± 24.5mmHg, the oxytocin group 114 ± 25.1mmHg, U = 2.114, P gt; 0.05 difference was not statistically significant. Before delivery diastolic blood pressure misoprostol group 87 ± 10.4mmHg, oxytocin group 85 ± 11.6mmHg U = 2.445, P gt; 0.05 difference was not statistically significant; diastolic blood after childbirth misoprostol group the 76 ± 15.3mmHg, oxytocin group 78 the ± 13.2mmHg, U = $ 258.3, P gt; 0.05 difference was not statistically significant. (4) The duration of labor: the misoprostol group 8.25 ± 2.31 minutes, 7.97 ± 2.82 minutes oxytocin group, U = 1.115, P gt; 0.05 difference was not statistically significant. (5) requiring transfusion: 8 misoprostol group, the oxytocin group 4, χ2 = 1.241, P gt; 0.05 difference was not statistically significant. 3. Adverse reaction of the security analysis indicators misoprostol main the maternal postpartum one hour chills, fever (≥ 38 ° C), nausea, vomiting and diarrhea. Misoprostol group and oxytocin group chills, fever χ2 88.588,45.319 P lt; 0.05 difference was statistically significant, but patients need special treatment, the symptoms go away in the short term. Conclusion: Rectal misoprostol 400 mcg effective prevention of postpartum hemorrhage, and the program and intravenous infusion of 20 international units of oxytocin program compared with a low cost, equal efficacy, the advantages of easy-to-use, it is recommended widely used in clinical The processing of the third stage of labor. Further large-scale randomized controlled trials to verify the same effect, to promote the use of medical resource-poor countries and regions.

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CLC: > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological delivery (abnormal delivery) > Childbirth and postnatal complications > Postpartum hemorrhage
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