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Re: Cytotec and postpartum hemorrhage From: art fougner, md (evsono@pipeline.com) Sat Jul 19 11:36:37 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anna Meenan, MD: "Re: Labor definition" Previous message: art fougner, md: "Re: Cytotec and postpartum hemorrhage" In reply to: Steve & Eryl Raymond: "Re: Cytotec and postpartum hemorrhage" Next in thread: Braun, R. Daniel: "Re: Cytotec and postpartum hemorrhage" Cochrane weighs in - Cochrane Database Syst Rev. 2003;(1):CD003249. Related Articles, Links Treatment for primary postpartum haemorrhage. Mousa HA, Alfirevic Z. Department of Obstetrics and Gynaecology, Whiston Hospital, Warrington Road, Prescot, Merseyside, UK, L35 5DR. yn5@hotmail.com BACKGROUND: Primary postpartum haemorrhage is one of the top five causes of maternal mortality in both developed and developing countries. OBJECTIVES: The objective of this review was to assess the effectiveness and safety of pharmacological and surgical interventions used for the treatment of primary postpartum haemorrhage. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's trials register (April 2002). SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing pharmacological, surgical and radiological interventions for the treatment of primary postpartum haemorrhage. DATA COLLECTION AND ANALYSIS: Studies were assessed for eligibility and quality by reviewers independently. Data were extracted into pre-specified data sheets. Authors of the included study were contacted for more information. Analysis was by intention to treat. Results are presented as relative risk with 95% confidence intervals using the fixed effects model. MAIN RESULTS: One trial, comparing rectally administered misoprostol versus syntometrine combined with an oxytocin infusion, met the eligibility criteria and was included in the review. It was not large enough to evaluate the effects of rectal misoprostol on maternal mortality, serious maternal morbidity or hysterectomy rates in women with primary postpartum haemorrhage. Compared with a combination of intramuscular syntometrine injection and oxytocin infusion, rectal misoprostol administration showed a statistically significant reduction in the number of women who continued to bleed after the intervention and those who required medical co-interventions to control the bleeding (6% versus 34%) (relative risk 0.18, 95% confidence interval 0.04 to 0.67). However, there was no significant difference between the two groups regarding surgical interventions to control intractable haemorrhage including hysterectomy, internal iliac artery ligation and/or uterine packing. REVIEWER'S CONCLUSIONS: Rectal misoprostol in a dose of 800 micrograms could be a useful 'first line' drug for the treatment of primary postpartum haemorrhage. Further randomised controlled trials are required to identify the best drug combinations, route, and dose for the treatment of postpartum haemorrhage. art At Fri, 18 Jul 2003, Steve & Eryl Raymond wrote: > >It seems a good time to say that we have used 5 tablets (1 gram) >rectally in cases of post partum uterine atony with patchy results. I >don't want to say that it is no use at all, but there have been >occasions where I saw no improvement, and the results could be best >described as disappointing. A study done recently, the source of which >I have totally forgotten, showed results which were worse than all other >ecbolics in current use, but better than nothing or placebo!! >Steve > >Braun, R. Daniel wrote: > >>If the uterus is still floppy and bleeding after giving pit IV, then we >>put 600 mcg intrarectlly. Someone has to reach under the drapes to do >>it. >> >>Dan >> >>-----Original Message----- >>From: Glen Elrod MD [mailto:glen.elrod@elmendorf.af.mil] >>Sent: Thursday, July 17, 2003 4:32 PM >>To: Multiple recipients of list OB-GYN-L >>Subject: Re: Cytotec and postpartum hemorrhage >> >>I've never heard it being contraindicated in asthmatics either. >> >>Dr Braun...how do you use it after c/s? Regularly or just for >>hemorrhage after pit fails? >> >>Glen >> >>At Thu, 17 Jul 2003, Efrain Ramirez wrote: >> >>>Haven't heard it is contraindicated in asthmatics - ! >>> >>>If there is no Hamabate - you can use it - rectally or/and PO - I dont >>>think it is as good as Methergine or Hemabate. >>> >>>At Thu, 17 Jul 2003, Braun, R. Daniel wrote: >>> >>>>Cytotec is also a prostaglandin. Can't use in asthmatics either. >>>> >>>>We use it after C/S. It is our second choice after pitocin. >>>> >>>>-----Original Message----- >>>>From: Glen Elrod MD [mailto:glen.elrod@elmendorf.af.mil] >>>>Sent: Thursday, July 17, 2003 10:41 AM >>>>To: Multiple recipients of list OB-GYN-L >>>>Subject: Cytotec and postpartum hemorrhage >>>> >>>>Does anyone have any experience with Cytotec and postpartum hemorrhage >>>>in women that have just undergone a c-section. I know that Cytotec is >>>>contraindicated in women with a previous c-section for labor induction. >>>> >>>>I have used cytotec rectally for women with vaginal deliveries that have >>>> >>>>postpartum hemorrhage. >>>> >>>>The reason this came up is we have a postpartum c/s that is diabetic, >>>>asthmatic, preeclamptic with a postpartum hemorrhage. Methergine is >>>>out. Hemabate is out. Pitocin was running. Pt is now several hours >>>>out from surgery. Any other suggestion? >>>> >>>>Glen >>>> >>>>-- >>>>D. Glen Elrod, Maj, USAF, MC >>>> >-- >S.H. Raymond FRCOG >Principal Specialist >Department of Obstetrics & Gynaecology >Empangeni Hospital >Private Bag X20005 >Empangeni >SOUTH AFRICA 3880 > >Phone: (+27)-35-9028560 >Fax: (+27)-35-7922596 > -- art fougner, md ich bin ein New Yorker Next message: Anna Meenan, MD: "Re: Labor definition" Previous message: art fougner, md: "Re: Cytotec and postpartum hemorrhage" In reply to: Steve & Eryl Raymond: "Re: Cytotec and postpartum hemorrhage" Next in thread: Braun, R. Daniel: "Re: Cytotec and postpartum hemorrhage"

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