The Use Misoprostol For Active Management Of Third Stage Of Labour:

Mohamed Fathy Mohamed

The third stage of labor is still the most important stage as its gravecomplications are direct factors in maternal morbidity and mortality.Fortunately, most of the complications of the third stage of labor arepreventable if managed carefully.The management of the third stage of labor is still controversialSome authors advocate conservative management ~hile others preferactive management to shorten the third stage and thus minimizing, aspossible - its complications.The active management of the third stage of labor is the one which isrecommended by most obstetricians. Several methods of activemanagement have been described as Brandt-Andrews methods, cordtraction or routine manual separation of the placenta.The use of prophylactic oxytocics in the management of the thirdstage is widely accepted.The most commonly used oxytocics are the oxytocin, or its syntheticforms as syntocinon or pitocin, ergot alkaloids as ergometrine or methylergometrine (methergine) which are the two preparations commonly used,and prostaglandins or its derivatives such as misoprostol which is aprostaglandin El analogue (cytotec or misotac).This study was conducted on two hundred parturients attending thedepartment of obstetrics and gynecology, Benha Faculty of Medicine,Zagazig University.The aim of this work was to compare the efficacy, safety of oralmisoprostol and syntometrine in management of third stage of labor as well as the adverse effects of both drugs.Our subjects have been divided into two comparable groups:• Misoprostol group (group A) given oral rnisoprostol (600J.1g)orally justafter clamping of the cord.• Syntometrine group (group B) given combined oxytocine 5 ill andergomentrin O.5mg (syntometrine) intramuscularly just after clampingof the cord.No mechanical intervention for delivery of the placenta was doneuntil the signs of placental separation appeared.The length of the third stage, the amount of blood loss during andafter the third stage of labor for one hour after delivery was estimatedclinically and by hematologic study. The occurrence of postpartumhemorrhage, the incidence of manual separation of the placenta, the needfOT further therapeutic oxytocics and the adverse effects were also reported.Oral rnisoprostol was found to be more effective, more safe and lessadverse effects than intramuscular syntometrine in management of thirdstage oflabor.The present study revealed the following:1- The administration of oral misoprostol shortens the third stage of labor when compared with the intramuscular syntometrine.2- The administration of oral rnisoprostol reduces the amount of blood lossduring the third stage of labor and it’s reflection on the hematologicvalues (Hb%, Hematocrite) when compared with intramuscularsyntometrine.3- With oral administration of misoprostol the incidence of manualseparation of the placenta with it’s complications is much lower thanwhen compared with intramuscular syntometrine.4- The side effects of oral misoprostol as regard its occurrence andseverity are lower in misoprostol group than in syntometrine group.In conclusion:Oral misoprostol has a significant effect on shortening the durationand reducing the blood loss of the third stage of labor when compred withintramuscular syntometrine and also, the incidence of manual separtation ofthe placenta and subsequent administration of therapeutic oxytocics was reduced.Thus the availability of an oral, effective, safe, thermostable drug,with less adverse effects for routine management of the third stage oflabormay have considerable benefits in preventing postpartum haemorrhage andperhaps reduce maternal morbidity and mortality in developing countries.