Efficacy of rectal misoprostol as second-line therapy for the treatment of primary postpartum hemorrhage.

摘要

OBJECTIVE: To assess the efficacy of rectal misoprostol as second-line therapy in the management of primary postpartum hemorrhage (PPH) as compared to methylergonovine maleate. STUDY DESIGN: This was a retrospective cohort study. Charts from July 2000 to February 2005 were reviewed. Inclusion criteria were patients between 37 and 42 weeks' gestational age who received a clinical diagnosis of PPH following delivery of a singleton pregnancy and who required a second uterotonic following initial oxytocin therapy. The control group represented those receiving methylergonovine maleate (18 patients), and the study group consisted of those receiving misoprostol (40 patients). RESULTS: There was no significant difference in maternal age, gestational age, parity or type of delivery between the 2 groups. There was no significant difference between the 2 groups in the need for blood transfusion (methylergonovine maleate group, 0/18 [0%], misoprostol group, 5/40 [12.5%] [p = 0.11]), the need for third-line medicaltherapy (methylergonovine maleate group, 10/18 [55.5%], misoprostol group, 22/40 [55%] [p = 0.961) or the need for any surgical intervention (methylergonovine maleate, 4/18 [22.2%], misoprostol 5/40 [12.5%] [p = 0.51]). CONCLUSION: This limited study suggests that rectal misoprostol is comparable to methergine as second-line therapy for the treatment of 1 primary postpartum hemorrhage.