19795
document
Buccal misoprostol to decrease blood loss after vaginal delivery : a randomized trial . OBJECTIVE To assess the efficacy of buccal misoprostol to decrease bleeding after vaginal delivery . METHODS This was a randomized study of patients between 22 weeks and 42 weeks of gestation with anticipated vaginal delivery . Patients were given either a 200-mug misoprostol tablet or placebo in the buccal space at the time of cord clamping . A continuous dilute intravenous oxytocin infusion was given to all patients at delivery of the placenta . Postpartum hemorrhage was defined as blood loss exceeding 500 mL . Sample size calculations based on previous studies assumed a 13 % incidence of postpartum hemorrhage in the control group . To show a statistically significant reduction of postpartum hemorrhage a total of 1,604 patients would be required in each group . RESULTS A total of 848 patients were enrolled and 756 randomly assigned , 377 in the misoprostol group and 379 in the placebo group . Demographic , antepartum , and intrapartum characteristics were similar between the groups . The incidence of postpartum hemorrhage , 3 % compared with 5 % , ( relative risk 0.65 , 95 % confidence interval 0.33-1.29 , P = .22 ) , mean estimated blood loss , 322 compared with 329 mL , ( P = .45 ) , and mean minutes of the third stage of labor , 6.7 compared with 6.9 ( P = .52 ) were similar between the groups , misoprostol and placebo , respectively . Hemoglobin difference before and after delivery , need for second or third uterotonic agent , and all measured neonatal variables including birth weights , and umbilical cord pH were similar between the groups . CONCLUSION Buccal misoprostol at cord clamping is no more effective than placebo in reducing postpartum hemorrhage .
19796
Intervention_Pharmacological
Buccal misoprostol
19797
Intervention_Pharmacological
buccal misoprostol
19798
Intervention_Pharmacological
200-mug misoprostol tablet
19799
Intervention_Control
placebo
19800
Intervention_Pharmacological
oxytocin
19801
Intervention_Pharmacological
misoprostol
19802
Intervention_Control
placebo
19803
Intervention_Pharmacological
misoprostol
19804
Intervention_Control
placebo
19805
Intervention_Pharmacological
Buccal misoprostol
19806
Intervention_Control
placebo
19807
Outcome_Physical
blood loss
19808
Outcome_Physical
bleeding
19809
Outcome_Physical
Postpartum hemorrhage
19810
Outcome_Physical
blood loss
19811
Outcome_Physical
incidence of postpartum hemorrhage
19812
Outcome_Physical
mean estimated blood loss
19813
Outcome_Physical
mean minutes of the third stage of labor
19814
Outcome_Physical
postpartum hemorrhage .
19815
Participant_Condition
after vaginal delivery :
19816
Participant_Condition
after vaginal delivery .
19817
Participant_Condition
vaginal delivery
19818
Participant_Sample-size
1,604 patients
19819
Participant_Sample-size
848 patients
19820
Participant_Sample-size
756
19821
Participant_Sample-size
377 in the misoprostol group
19822
Participant_Sample-size
379 in the placebo group
19823
Participant_Condition
Demographic , antepartum , and intrapartum characteristics were similar between the groups