Prevention of Postpartum Haemorrhage With Sublingual Misoprostol or Oxytocin
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Purpose
Sublingual misoprostol produces rapid peak concentration and is more effective than oral misoprostol for prevention of excessive postpartum bleeding. The study hypothesis was to test whether women receiving sublingual misoprostol for prevention of postpartum hemorrhage have 30 ml less average blood loss than women receiving oxytocin, the standard of care for prevention of postpartum hemorrhage. We conducted a Double blind randomized controlled trial of .652 consenting, eligible pregnant women admitted to the labor room of the teaching hospital at J N Medical College, Belgaum, India. Women participating in the study were assigned by computer generated randomization to receive the study medications and placebos within one minute after clamping and cutting the umbilical cord. We also looked at the drugs effects on postpartum blood loss at or above ≥500 ml (considered hemorrhage), and the percent of women experiencing more than a 10% decline in haemoglobin, and reported drug side effects.
| Condition | Intervention | Phase |
|---|---|---|
|
Postpartum Hemorrhage |
Drug: Misoprostol Drug: Oxytocin |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver) Primary Purpose: Prevention |
| Official Title: | A One Year Double Blind Randomized Controlled Trial of Sublingual Misoprostol (400 µg) Versus Intramuscular Oxytocin (10 IU) in the Prevention of Postpartum Bloodloss at KLE Hospital, Belgaum |
- mean blood loss [ Time Frame: 2 hours after delivery ] [ Designated as safety issue: No ]Blood loss was objectively measured using the BRASSS-V DrapeTM, placed under the buttock before the delivery. The calibrated blood collection receptacle was opened after the delivery and drainage of amniotic fluid. Blood collected in the drape was transferred to measuring jar with 10 ml calibrations for accuracy. Blood soaked swabs were weighed in grams, and the known dry weight of the swabs was subtracted; this volume was added to the drape's measured blood volume (assuming 1 gm equivalence with 1 ml).
- postpartum hemorrhage (Blood loss >500 mls) [ Time Frame: 2 hours after delivery ] [ Designated as safety issue: No ]Blood loss was objectively measured using the BRASSS-V DrapeTM, placed under the buttock before the delivery. The calibrated blood collection receptacle was opened after the delivery and drainage of amniotic fluid. Blood collected in the drape was transferred to measuring jar with 10 ml calibrations for accuracy. Blood soaked swabs were weighed in grams, and the known dry weight of the swabs was subtracted; this volume was added to the drape's measured blood volume (assuming 1 gm equivalence with 1 ml).
- The percent of women experiencing a ≥10% postpartum decline in haemoglobin [ Time Frame: At presentation for delivery and 12-48 hours after delivery ] [ Designated as safety issue: No ]Hemoglobin was obtained at presentation for delivery and again between 12 and 48 hours after delivery.
- Medication side effects [ Time Frame: 2 hours after delivery ] [ Designated as safety issue: Yes ]Self reported side effects including nausea, vomiting, diarrhoea, abdominal pain, shivering and elevated temperature
| Enrollment: | 652 |
| Study Start Date: | March 2007 |
| Study Completion Date: | January 2008 |
| Primary Completion Date: | January 2008 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Sublingual misoprostol
400 µg powdered misoprostol administered sublingually; IM placebo
|
Drug: Misoprostol
400 µg sublingual misoprostol
|
|
Active Comparator: Oxytocin
10 IU IM oxytocin; placebo powder
|
Drug: Oxytocin
10 IU IM
|
Eligibility| Ages Eligible for Study: | 18 Years to 35 Years |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Women with a gestational age >28weeks
- singleton pregnancy with cephalic presentation anticipating a normal spontaneous vaginal delivery (including episiotomy)
- a haemoglobin ≥ 8g/dl upon presentation who were admitted to labour room in the KLE teaching hospital attached to J N Medical College, Belgaum
Exclusion Criteria:
- Women with pregnancy induced hypertension
- antepartum haemorrhage
- previous caesarean section or presence of uterine scar
- diagnosed chorioamnionitis
- oxytocin induction or augmentation of labour
- intrauterine death
- diagnosed medical disorders (such as diabetes, cardiac, renal and hepatic diseases, etc.) or those in active labour (defined as >4 cm dilatation)
Contacts and Locations| India | |
| Jawaharlal Nehru Medical College | |
| Belgaum, Karnataka, India, 590010 | |
| Principal Investigator: | M B Bellad, M.D. | Jawaharlal Nehru Medical College |
More Information
No publications provided
| Responsible Party: | Dr. M. B. Bellad, Professor, Department. of Obstetetrics. & Gynaecology, KLE University Jawaharlal Nehru Medical College |
| ClinicalTrials.gov Identifier: | NCT01373359 History of Changes |
| Other Study ID Numbers: | MDC/DOME/3707 |
| Study First Received: | June 9, 2011 |
| Last Updated: | June 13, 2011 |
| Health Authority: | India: Institutional Review Board |
Keywords provided by Jawaharlal Nehru Medical College:
|
Misoprostol, oxytocin, postpartum blood loss, hemoglobin |
Additional relevant MeSH terms:
|
Hemorrhage Postpartum Hemorrhage Pathologic Processes Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage Oxytocin Misoprostol |
Oxytocics Reproductive Control Agents Physiological Effects of Drugs Pharmacologic Actions Therapeutic Uses Anti-Ulcer Agents Gastrointestinal Agents Abortifacient Agents, Nonsteroidal Abortifacient Agents |
ClinicalTrials.gov processed this record on May 22, 2013