Effect of Misoprostol in Reducing Post Partum Hemorrhage After Labor Induction by Oxytocin

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effect of Misoprostol in Reducing Post Partum Hemorrhage After Labor Induction by Oxytocin: a Prospective Randomized Controlled Trial

Conditions
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Prevention of Post Partum Hemorrhage After Labor Induction

Intervention / Treatment
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* Drug: Misoprostol after delivery
* Drug: Oxytocin after delivery
* Drug: Oxytocin before delivery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: women with single viable pregnancy, cephalic presentation, at full term whom labor was induced by Oxytocin were eligible Exclusion Criteria: delivery by cesarean section received other prophylactic uterotonics

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Misoprostol<br>Rectal misoprostol | Drug: Misoprostol after delivery<br>* Patients will receive 1000 mcg Misoprostol per rectum<br>Drug: Oxytocin before delivery<br>* 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<br>|
| Experimental: Oxytocin<br>intravenous oxytocin | Drug: Oxytocin after delivery<br>* Patients will receive 20 units oxytocin intravenously in one liter of Lactated Ringer solution at a rate of 150ml/h<br>Drug: Oxytocin before delivery<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemoglobin level | 10% or more drop in hemoglobin | 12 to 24 hours post partum | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean hemoglobin drop | difference between pre and post partum hemoglobin levels | 12 to 24 hours post partum | 
| mean estimated blood loss | visual estimation of blood loss | during the first hour post partum | 
| drop in hemoglobin | 2g/dl drop in hemoglobin | 12 to 24 hours post partum | 
| side effect of medication | fever > 38°C, diarrhea, and shivering | upto 48 hours after delivery |