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Abstract
Third stage of labor is a critical stage for the management and prevention of postpartum hemorrhage and is defined as the period between the delivery of baby and placenta.
In active management of third stage of labor we enhance the separation and delivery of placenta by increasing uterine contractions to control the blood loss and decreasing the risk of postpartum hemorrhage.
Active management of third stage of normal labor including:
1- Adminstration of utrotonic medications after delivery of the baby.
2- Early clamping and cutting the umbilical cord.
3- Controlled traction of umbilical cord while separation and delivery of the placenta.
Utrotonic medications are:
1- oxytocin.
2- ergot alkaloids.
3- syentometrien.
4- misoprostol.
Misoprostol is a prostaglandin E1 analogue and it is one of the cheapest prostaglandin, easy used and stored.
(Cytotec) is available as tablet that can be administered by oral, sublingual, recta or vaginal route.
It is stable at room temperature and inexpensive.
The use of rectal misoprostol is proliferating around the world.
It is a life saving treatment for sever postpartum hemorrhage and its also used to reduce blood loss during labor.
It is also used in induction of labor and induction of abortion.
Also it has other non obstetric use as its used in the treatment of peptic ulcer.
In this study we used to give misoprostol rectally in doses of 200,400,600 microgram after delivery of the baby as utrotonic drug an active management of third stage of labor and inspecting its effect on reducing blood loss and its side effects.
The aim of this study is to compare between three different doses of rectal misoprostol and control group in active management of third stage of labor.
The study composed of 400 pregnant full term women in labor were randomly allocated into four groups:
Group 1 (100 women):
They received 200 microgram of rectal mioprostol immediately after delivery of the baby.
Group 2(100 women):
They received 400 microgram of rectal mioprostol immediately after delivery of the baby.
Group 3(100 women):
They received 600 microgram of misprostal rectally immediately after delivery of the baby.
Group 4(100 women):
They received placebo tablets immediately after delivery of the baby.
All cases were followed after delivery for possible occurrence of postpartum hemorrhage and for measuring the amount of blood loss during the third stage of labor.
Drug side effects will also reported in all cases including
Conclusion of this study is:
1- Active management of third stage of normal labor is better than expectant management as it decreases the amount of blood loss during the third stage of normal labor and also decreases the incidence of occurrence of post partum hemorrhage.
2- Active management of the third stage of normal labor including:
A) Use of utrotonic medications after delivery of the baby.
B) Early clamping and cutting the umbilical cord.
C) Controlled traction of umbilical cord while separation and delivery of the placenta.
3- Misoprostol is an effective utrotonic drug when given rectally during the third stage of labor.
4- Higher doses of misoprostol (600 microgram rectally) is more effective in management of the third stage of normal labor as it has the lowest amount of blood loss and least incidence of occurrence of postpartum hemorrhage .
5- The most common side effect of rectal misoprostol is shivering and fever and they increase when increasing the dose but were relieved spontaneously or by antipyretic drugs.