The Effectiveness of Rectal Misoprostol after Child Birth in Reduction of Postpartum Blood Loss at the National Hospital Abuja

Abstract

Background: Over the years postpartum haemorrhage (PPH) remained an important cause of maternal morbidity and mortality. Efforts to reduce the incidence of PPH resulted in the introduction of active management of the third stage of labour. The use of rectal misoprostol in the immediate postpartum period has been reported to reduce postpartum haemorrhage. Aim of the study: The study seeks to determine the efficacy of administering prophylactic 600 micrograms rectal misoprostol immediately after the delivery of the placenta in reducing postpartum blood loss. Methods: This was a prospective comparative study in which eligible consenting parturients were randomized into two groups. In addition to other measures of active management of the third stage of labour, the study group received 600 micrograms of rectal misoprostol immediately after delivering the placenta. The primary outcomes measured were estimated blood loss and haemoglobin change from the intrapartum value. The secondary outcomes were misoprostol side effects and the need for blood transfusion. Results: Three hundred and twenty parturients were recruited for the study but 318 were analysed. One hundred and fifty-three were randomised to the study group while 165 were in the control group. There were statistically significant differences in the estimated mean blood loss and mean haemoglobin change of the two groups (P<0.0001). The estimated mean blood loss and mean haemoglobin change in the study group were 153 ± 45.1ml and 0.5 ± 0.2g/dl respectively; while in the control group were 230.6 ± 76.9ml and 0.8 ±0.3g/dl respectively. Thirty-seven per cent of the control group had estimated blood loss ≥ 250mls while 2.6% of the study group had estimated blood loss ≥ 250mls. Only 1 person in the study and 2 persons in control groups received a blood transfusion. Sixteen (9.7%) in the control group and 6 (3.9%) in the study group received additional uterotonic agents. The difference was statistically significant with a p-value of 0.005. Fifteen (9.8%) of the study group had abdominal pain, 24 (15.7%) had shivery and 9 (5.9%) had nausea. However, only shivering reached statistical significance (p=0.028). All the recorded side effects were self-limiting and there was no maternal death. Conclusion: Prophylactic 600 microgram rectal misoprostol given immediately after delivery of the placenta is effective in reducing postpartum blood loss and the need for blood transfusion.