Comparison Of Sublingual Misoprostol And Intramuscular Oxytocin In Management Of 3Rd Stage Of Labour In Kenyatta National Hospital
Abstract
Introduction: Third stage of labor is defined as the part of labor from the birth of the baby until
the placenta (afterbirth) and fetal membranes are delivered. (1).Signs of third stage of labor
includes, gush of fresh blood, and cord lengthening, globular and firm uterus and rise of the
uterus anteriorly.
Everyday 800 women die from pregnancy or child birth related complications around the world,
of these deaths most of them occur in developing countries. In 2013 for example 289,000 women
died during and following pregnancy and child birth.(2).Of the global causes of maternal
mortality;27% is attributed to severe bleeding after delivery,28% to pre-existing conditions,14%
to pregnancy induced high blood pressure,8% to complications following abortion,11% to
infections,9% by obstructed labor and other causes,3% to blood clots and embolism.(2).PPH is
defined as blood loss of more than 500mls following vaginal delivery or more than 1000mls
following cesarean section delivery. A loss of these amounts within the first 24hrs of delivery is
referred to as primary PPH, whereas such an amount of blood loss occurring after 24hrs is
termed as secondary PPH.WHO recommends the use of oxytocin 10i.u intramuscular in
prevention of PPH. On the other hand, sublingual misoprostol is affordable, rapidly absorbed,
efficacious and doesn’t require refrigeration. There is little data on the effectiveness of
misoprostol in comparison to oxytocin for prevention or management of third stage of labor in
our set up.
Objective: To compare sublingual misoprostol 600 ug with intramuscular oxytocin 10 i.u.
in management of 3rd stage of labor in low-risk vaginal birth at KNH.
Design: This study was an open blind randomized clinical trial.
Setting: Labor ward at Kenyatta National Hospital.
Sample size: 144 mothers who met the inclusion criteria were sampled out for inclusion in the
study.
Methods: open blind randomized clinical trial was used at Kenyatta National Hospital from May
2016 through July 2016, 72 women were administered 10i.u oxytocin intramuscular while 72
women were given sublingual misoprostol 600mcg after the delivery of the anterior shoulder.
The time taken to deliver the placenta was recorded, the amount of blood loss was estimated and
the need for additional uterotonics was compared.
Data management: Data analysis was conducted using STATA version 12 (College Station,
Texas. US). Initial descriptive analysis of patients was conducted according to treatment group to
determine success of randomization. Continuous variables including age, were summarized using
means and standard deviation and comparisons between the treatment arms was conducted using
Student’s t-test. The categorical variables e.g. education level were analyzed by calculating
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frequencies and percentages followed by comparisons of frequency distributions conducted using
Pearson’s chi square test.
Main outcome measure: The primary outcome was the mean duration of third stage of labor.
The mean duration (SD) of third stage was calculated in the two groups and based on tests of
normality of residuals either a Student’s t-test (normal distribution) or a Mann-Whitney test
(skewed distribution) used for comparisons. The two secondary outcomes namely proportion of
additional uterotonics used and proportion of excessive blood loss were determined through
recording the respective variables into binary variables and calculating the corresponding
percentages. Comparison of these outcomes and treatments were conducted using chi-square test.
The magnitude of effect was presented as odds ratios and 95% confidence intervals derived from
logistic regression models. For all analysis statistical significance was determined using a cut-off
value of 0.05.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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