Effectiveness of oral misoprostol versus placebo for prevention of postpartum haemorrhage

Background and Objective: The clinical definition states “any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerperium which adversely affects the general condition”3. Postpartum haemorrhage is a leading cause of maternal morbidity and mortality. In India it accounts for 25-30% of maternal deaths1. Uterine atony accounts for 80% cases of primary PPH. Most uterotonics require parental administration, maintenance of cold chain which is necessary for their potency and which is not always possible in some peripheral centre’s. Misoprostol a prostaglandin E1 analogue does not need refrigeration, has long shelf life and is stable at high temp. It is very effective for prevention of PPH. Methodology: Prospective study was conducted in Lalla Ded hospital; associated hospital of Government medical College Srinagar, the only tertiary care hospital for Gynecology and Obstetrics in the Kashmir Valley over a period of 18 months. Sample size: The number of patients was 200. Group A: 100 patients (study group) received 600g of oral misoprostol immediately after delivery of the baby. Group B: 100 patients (control group) received 3 tabs of placebo similar in appearance. Our study was primarily designed to study the effectiveness of misoprostol (oral) for prevention of postpartum haemorrhage (PPH). The primary outcomes measured were : amount of blood loss, pre-delivery and post delivery haematocrit, haemoglobin pre delivery and post delivery, duration of third stage of labour, need for manual removal of placenta, need for other oxytocics, need fof blood transfusion and side effects of misoprostol were also recorded