Effect of Misoprostol in Reducing Post Partum Hemorrhage After Labor Induction by Oxytocin
Condition: Prevention of Post Partum Hemorrhage After Labor Induction
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      The use of Oxytocin for labor induction may cause receptor exhaustion and thus making its use
      in the third stage of labor ineffective in reducing post partum blood loss as compared to
      other uterotonics.So, we studied the effect of other uterotonic which is misoprostol in
      reducing post partum hemorrhage.
    

Detailed description: 
      Our study will be carried out at Makassed General Hospital, a tertiary-level maternity unit
      performing about 1000 deliveries annually. After approval by the hospital Ethics and Research
      Committee, women with single viable pregnancy, in cephalic presentation, at full term and
      whom labor was induced by Oxytocin will be eligible for inclusion.

      After informed consents is obtained, the parturients will be assigned randomly according to a
      computer generated sequence in block lists of 25each time to receive either 1000mcg of
      Misoprostol rectally or 20 units of Oxytocin intravenously to run at a rate of 150ml/hr. The
      medications will be given just after cord clamping and before delivery of the placenta.
      Active management of the third stage of labor will be carried out simultaneously with early
      cord clamping, gentle downward traction of the placenta to hasten its delivery, and uterine
      massage in addition to the uterotonic according to assignment of the patient. Assessment of
      the uterine condition will be done by the obstetrician or his assistant, together with
      visually estimating the amount of blood loss. Once uterine atony or estimated blood loss
      (EBL) of more than 500 ml is noticed, another uterotonics will be administered according to
      the condition and at the discretion of the obstetrician.

      Failure to achieve adequate uterine contraction and to control post partum hemorrhage (PPH)
      by the routine uterine massage will urge the use of either different uterotonics or surgical
      intervention if necessary. Blood transfusion will be ordered for the cases whose visual
      estimation of blood loss is more than 1000ml or when the patient was hemodynamically
      unstable. In order to compare the effect of each medication alone on the amount of blood
      loss, we will then exclude those patients who received blood transfusion or additional
      uterotonics. A base line hemoglobin and hematocrit levels will be withdrawn on admission and
      another reading 12 hours postpartum.
    

Intervention name(s): Misoprostol after delivery; Oxytocin after delivery; Oxytocin before delivery
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Patients will receive 1000 mcg Misoprostol per rectum; Patients will receive 20 units oxytocin intravenously in one liter of Lactated Ringer solution at a rate of 150ml/h; All patients will receive oxytocin 0.5-1 milliUnit/min IV, titrated to 1-2 milliUnit/min every 15-60 min before delivery to induce labor
Intervention MeSH terms: Misoprostol; Oxytocin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention