Objectives: Our study compared between sublingual, oral and rectal misoprostol as regard efficacy and side effects in preventing primary a tonic postpartum hemorrhage.
Patients and methods: This comparative prospective study was carried out on 300 parturient women admitted to Benha University Hospital in the Department of Obstetrics and Gynecology. These women were divided into three equal groups. Group A received 400 micrograms of sublingual misoprostol, while group B received 400 micrograms of misoprostol orally and group C received 400 micrograms of rectal misoprostoly. The amount of blood loss was measured after delivery of baby and clamping of umbilical cord. The primary data were the occurrence of primary atonic postpartum hemorrhage despite given misoprostol. The secondary data included the need for extra misoprostol tablets by either these routes or use of secondary drug (oxytocin) or methergin .
Results: Our results showed no statistically significant difference between the three groups as regard general data and parity. Sublingual group had shorter duration compared to rectal and oral groups. Oral group had the highest frequency of postpartum hemorrhage, most frequenty required uterotonics and had the highest amount of blood loss compared to rectal and sublingual groups with statistically significant difference. Hemoglobin level was declined after treatment with statistically highly significant difference compared to the level before treatment. Fever, shivering and GIT complications were the most frequent among oral group compared to rectal and sublingual groups with statistically highly significant difference.
Conclusion: 400 μg of sublingual misoprostol were more effective than 400 micrograms of oral misoprostol and 400 micrograms of rectal misoprostol as a prophylaxis against primary atonic postpartum hemorrhage.
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