Roundtable: Making Pregnancy Safer in Myanmar: Introducing Misoprostol to Prevent Post-Partum Haemorrhage as Part of Active Management of the Third Stage of Labour

2007 ◽  
Vol 15 (30) ◽  
pp. 214-215 ◽  
Author(s):  
Thein Thein Htay
Keyword(s):  
Post Partum ◽  
Active Management ◽  
The Third ◽  
Third Stage ◽  
Post Partum Haemorrhage

scholarly journals OBSTETRIC CHOLESTASIS

2003 ◽  
Vol 41 (142) ◽  
pp. 335-340
Author(s):  
Pramila Pradhan
Keyword(s):  
Perinatal Mortality ◽  
Maternal Morbidity ◽  
Post Partum ◽  
Active Management ◽  
Close Monitoring ◽  
The Third ◽  
Oestrogen Level ◽  
Increased Risk ◽  
Third Stage ◽  
In Pregnancy

Obstetric Cholestasis is the commonest liver disease that causes pruritis and is uniqueto pregnancy. Pruritis can be so intense as to lead insomnia.The Significance of thisdisease has been highlighted more recently due to the associated perinatal mortalityand maternal morbidity. Aetiology and pathophysiology still uncertain. There, appearsto be genetic predisposition in certain individuals resulting in an increasedsusceptibility to the high oestrogen levels found in pregnancy specially in 3rdtrimesterand resolving promptly after delivery when oestrogen level falls rapidly. Pruritis iscentral in origin and thus fails to respond to commonly used antihistamines and lotiocalamine locally. Recently ursodeoxycholic acid an exogenous bile acid is increasinglybeing used and showed improved both pruritis and liver function and favourablechanges were observed in the foetus as well. Delivery planned at 37-38 weeks ofgestation reduced perinatal mortality. Because of increased rate of adverse intrapartumevents, close monitoring is appropriate. Active management of the third stage isnecessary because of the increased risk of post partum haemorrhage.Key Words: Pruritis, pregnancy, planned delivery, perinatal mortality and maternal morbidity.

scholarly journals Comparison of Oral Misoprostol with Intramuscular Oxytocin in the Active Management of Third Stage of Labour

2015 ◽  
Vol 10 (1) ◽  
pp. 76-80
Author(s):  
S Kaudel ◽  
A Rana ◽  
N Ojha
Keyword(s):  
Blood Transfusion ◽  
Post Partum ◽  
University Teaching ◽  
Active Management ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. Methods: This prospective comparative study was performed in Tribhuvan University Teaching Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage. One hundred and twenty women without risk of PPH were randomly allocated to receive either 600 mcg misoprostol orally (Group A) or 10 unit of oxytocin intramuscularly (Group B) within 1 minute of delivery. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in hemoglobin (Hb) and hematocrit (Hct) level from before delivery to 8 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Oral misoprostol was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage (PPH). There was no statistical difference in the duration of third stage of labour, need for additional uterotonics, need for uterine exploration/evacuation and need for blood transfusion in the two groups. Conclusions: Routine use of oral misoprostol 600 mcg appears to be as effective as 10 IU intramuscular oxytocin in minimizing blood loss during the third stage of labour.

scholarly journals Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

2017 ◽  
Vol 6 (2) ◽  
pp. 516 ◽  
Author(s):  
Moussa Diallo ◽  
Toura Sylla ◽  
Abdoul Aziz Diouf ◽  
Phillipe Marc Moreira ◽  
Omar Gassama ◽  
...  
Keyword(s):  
Average Rate ◽  
Post Partum ◽  
Low Risk ◽  
University Hospital ◽  
Active Management ◽  
Controlled Clinical Trial ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Misoprostol Group

Background: Assess the effectiveness of oral misoprostol as an alternative to oxytocin in the active management of the third stage of labour in Dakar/Senegal.Methods: Randomized controlled clinical trial conducted in the maternity ward of a university hospital on 304 women who had vaginal delivery. These women were randomly assigned into 2 groups based on active delivery conditions: the first group received an oral administration of misoprostol (400 mcg) and the second group 5 IU oxytocin through intravenous route.Results: The average volume of blood loss was 196.55 ml in the misoprostol group and 208.39 ml in the oxytocin group (p=0.63). The incidence of postpartum haemorrhage (>500 cc) was 6.49% in the misoprostol group and 9.33% in the oxytocin group (p=0.358). The average rate of haemo globin decline was 0.38 g/dl in the misoprostol group and 0.29 g/dl in the oxytocin group (p=0.99). The proportion of hyperthermia, shivering, and nausea in the misoprostol and oxytocin groups were respectively: 2.59% against 0.6% (p=0.123), 7.14% against 2% (p=0.001) and 2.59% against 0.6% (p=0.498).Conclusions: In Senegal, Misoprostol despite its side effects, is an effective alternative to oxytocin in the active management of the third stage of labour for low-risk parturient women to reduce the risk of maternal deaths due to post-partum hemorrhage.

scholarly journals Active management of third stage of labour, post–partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

2010 ◽  
Vol 2 (1) ◽  
Author(s):  
Jean-Pierre Fina Lubaki ◽  
Jean-Robert Musiti Ngolo ◽  
Lucie Zikudieka Maniati
Keyword(s):  
Maternal Death ◽  
Democratic Republic ◽  
Post Partum ◽  
Active Management ◽  
Maternal Deaths ◽  
Third Stage ◽  
Post Test ◽  
Republic Of The Congo ◽  
Health Zone ◽  
Post Partum Haemorrhage

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone.Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest.Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths – two of which were related to PPH – were reported during the study period, which means there was a decline of 70% compared with the previous two years.Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives.

Active Management of Third Stage Labor Is Associated with a Lower Cord Blood Unit Volume.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5282-5282
Author(s):  
Valerie Lapierre ◽  
Stephane Maddens ◽  
Stephanie Vuillemin ◽  
Chrystelle Vidal ◽  
Michelle Menetrier ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cord Blood ◽  
Post Partum ◽  
Univariate Analysis ◽  
Active Management ◽  
Cell Content ◽  
Second Stage ◽  
Cd34 Cells ◽  
Third Stage ◽  
Post Partum Haemorrhage

Abstract Aim: It has been demonstrated that active management of third stage of labour (AMTSL) (prophylactic administration of a uterotonic agent, early cord blood clamping and controlled cord blood traction) reduces the risk of primary post partum haemorrhage compared with expectant (or physiological) management. However this strategy might decrease the cord blood unit (CBU) volume which is collected in order to be banked for therapeutic use. Knowing that efficacy of CBU transplantation correlates with CD34+ progenitor cells content (which is correlated with the collected volume of CBU), we conducted a retrospective study to analyse the impact of AMTSL on volume and CD34 progenitor’s content of CBU. Material and Method: From Jan 1st 2001 to Oct 2nd, 2004 the maternity affiliated to the Besançon CBB performed 3838 CBU collections after normal deliveries. Different factors that might impact on CBU volume and CD34+ cell content were analysed: age, parity, and smoking habit of the mother, gestational age, type of initiation and duration of first labour stage, duration (from the beginning of labour to initiation of the pushing phase), time of the second stage of labour (from the initiation of pushing time to the birth of the baby), foetal cardiac rhythm (FCR) alterations during labour, type of delivery (assisted or not) and variables of the third stage of labour (AMTSL, uterine revision, primary post partum haemorrhage occurrence, placenta weight). Moreover, variables in relation with the baby were studied: sex, weight, Apgar score at 1 and 5 minutes. Each factor were submitted to a univariate analysis. Multivariate analysis was carried only onto factors significant after univariate analysis. Analysis concerning volume was performed on all 3838 CBU while analysis for CD34+ cells content was performed only on CBU with a volume > 80 ml (minimum volume required for banking in our CBB) Results: In univariate analysis, assisted initiation of first stage of labour (p=0.04), FCR modification during labour (p=0.01), uterine revision (p=0.01), primary post partum haemorrhage (p=0.01), gestational stage (p=0.0001), duration of second stage labour (P=0.0001), placenta and baby weight (both p=0.0001) instrumental expulsion (p= 0.0001) and male baby (p=0.01) were associated with higher CBU volume. Conversely, AMSTL (p= 0.01) and Apgar sore at 1 and 5 minutes (p=0.0007 and 0.004 respectively) were associated with lower CBU volume. In multivariate analysis, only assisted initiation of first stage of labour (p=0.02), primary post partum haemorrhage (p=0.0001), duration of second stage labour (P=0.003), placenta and baby weight (both p=0.0001) were associated with higher CBU volume. However, AMSTL (p= 0.03) and Apgar sore at 1 (p=0.003) were associated with lower CBU volume. Concerning CD34+ cells, in multivariate analysis, only maternal age (p=0.02), gestational stage (p=0.0001), FCR modification during labour (p=0.001), duration of second stage labour (p=0.0001), placenta and baby weight (respectively p= 0.001 and p=0.0001) were associated with higher CD34+ cells content in CBU. Conversely, only Apgar sore at 1 (p=0.0001) was associated with lower CD34+ cells content in CBU. Conclusion: AMSTL is associated with a low CBU volume but not with a low CD34+ cell count. In view of the know generalized use of AMSTL, such findings could have on impact on the determination of volume and CD34+ cell content threshold required for CBU banking.

scholarly journals Intramuscular oxytocin 10 units versus intravenous methylergometrine 0.2 mg in active management of third stage of labour for prevention of postpartum haemorrhage: a comparative study

2020 ◽  
Vol 9 (2) ◽  
pp. 494
Author(s):  
Divya Narayana ◽  
B. Pathak ◽  
Abha Khurana ◽  
Uttara Aiyer Kohli
Keyword(s):  
Side Effects ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Post Partum ◽  
Tertiary Care ◽  
Active Management ◽  
Normal Delivery ◽  
Post Partum Hemorrhage ◽  
The Third ◽  
Third Stage

Background: To compare the effectiveness of 10 IU of oxytocin IM with 0.2 mg methyl ergometrine IV in the prevention of post-partum hemorrhage when used as a part of active management of third stage of labour. This study aims to compare their influence on duration of the third stage of labour, the amount of blood loss during the third stage of labour and the immediate post-partum period and side effects of the drugs if any.Methods: The study was conducted in a tertiary care teaching hospital. 200 women, who underwent normal delivery with or without episiotomy, were enrolled and were randomly distributed into two groups. 100 women received 10 IU of intramuscular Oxytocin and 100 women received intravenous 0.2 mg of methyl ergometrine. Women of both the groups were given the medication after delivery of anterior shoulder of the baby. Comparison done between percentages fall in Hb from before delivery to 24 hours after delivery, need for additional uterotonic agents, need for blood transfusion, duration of third stage of labour and any side effects including retained placenta and need for manual removal of placenta.Results: Intravenous methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage. There was no difference in the duration of third stage of labour, amount of blood loss, need for additional uterotonic agents, and need for blood transfusion in both the groups. There was no significant side effect in both the groups.Conclusions: Intramuscular oxytocin is as efficacious as Intravenous methylergometrine in the prevention of postpartum hemorrhage with no side effects.

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