OBJECTIVE: To determine the efficacy of Carboprost versus methylergometrine maleate in the active management of third stage of labor for the prevention of postpartum hemorrhage.

METHODS: Entries in electronic databases with references cited in original studies and review articles were used to identify randomized clinical trials of carboprost versus methergin in the active management of third stage of labor. The quality of published clinical trials were evaluated and assessed based on the efficacy of Carboprost versus methylergometrine maleate for the prevention of postpartum hemorrhage.

RESULTS: Six (6) clinical trials were analyzed comprising a total sample pool of 525 women randomized to carboprost group and another 525 women to methergin. The risk ratio for dichotomous outcomes were calculated using a random-effects model while continuous outcomes were pooled using the standard mean difference. Results showed that both carboprost and methergin are both effective in preventing postpartum hemorrhage. But carboprost was found to be more efficacious in reducing the duration and decreasing the amount of blood loss in the third stage of labor and there was less need for an additional drug dose. Risks of side effects were higher in carboprost. Vomiting is the most frequent adverse event followed by diarrhea but are usually self-limiting.

CONCLUSION: Carboprost is well known for its therapeutic role in the management of postpartum hemorrhage, well-tolerated and with minimal adverse effects. It is therefore recommended to be used in hypertensive patients where methylergometrine maleate is contraindicated and in cases refractory to other uterotonic agents.

OBJECTIVE: Postpartum hemorrhage is most common cause of maternal mortality. Active management of third stage of labor minimizes the risk of postpartum hemorrhage. To compare the effect of methylergonovine and 15-methyl prostaglandin F2alpha (15-methyl PGF2alpha) in active management of third stage of labor. METHODS: A randomized open labelled parallel study with 50 women in normal labor, 25 in each group were included. The drugs methylergonovine (0.2 mg) intravenous and 15-methyl PGF2alpha (250 microg) intramuscular were administered at the time of delivery of anterior shoulder. Main outcomes measured were amount of blood loss during the first four hours of delivery and objective measurement of hemoglobin and hematocrit levels before delivery and third day postpartum. RESULTS: There was no statistically significant difference in the blood loss between the two groups at delivery (P = 0.130), at 1 hour of delivery (P = 0.453). The blood loss with 15-methyl PGF2alpha was significantly less as compared to that of blood loss with methylergonovine at four hours of delivery (P = 0.014) and the total, i.e., during first four hours, amount of blood loss was significantly less with 15-methyl PGF2alpha (P = 0.026). There was no statistically significant difference in the hemoglobin and hematocrit levels measured predelivery and postpartum third day between both the drugs. CONCLUSION: Both the drugs were effective in controlling the amount of blood loss during the third stage of labor, 15-methyl PGF2alpha being more efficacious.
Dinoprost ; Female ; Hematocrit ; Hemoglobins ; Humans ; Maternal Mortality ; Methylergonovine ; Postpartum Hemorrhage ; Postpartum Period ; Shoulder

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.
Blood Transfusion ; Carboprost ; Delayed Diagnosis ; Diagnosis* ; Erythrocytes ; Hematocrit ; Hemorrhage ; Hemostasis ; Hypovolemia ; Iliac Artery ; Maternal Mortality ; Methylergonovine ; Oxytocin ; Platelet Count ; Postpartum Hemorrhage* ; Postpartum Period* ; Resuscitation ; Sutures ; Tranexamic Acid ; Uterine Balloon Tamponade ; Uterus ; Vital Signs

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.
Blood Transfusion ; Carboprost ; Delayed Diagnosis ; Diagnosis* ; Erythrocytes ; Hematocrit ; Hemorrhage ; Hemostasis ; Hypovolemia ; Iliac Artery ; Maternal Mortality ; Methylergonovine ; Oxytocin ; Platelet Count ; Postpartum Hemorrhage* ; Postpartum Period* ; Resuscitation ; Sutures ; Tranexamic Acid ; Uterine Balloon Tamponade ; Uterus ; Vital Signs

Maternal mortality continues to be a major public health concern inspite of the advances in technology and research. Worldwide, postpartum hemorrhage (PPH) is cited as the major cause of mortality and morbidity, more so in developing countries. Active management of third stage of labor (AMTSL) is the treatment of choice in preventing PPH.

OBJECTIVE: The goal of this study was to determine the efficacy of intraumbilical vein injection of oxytocin versus IV oxytocin infusion in the AMTSL. It is meant to provide an alternate route that is more efficacious and practical.

METHODS: In this prospective, randomized, single-blinded clinical trial comparing the efficacy of intraumbilical vein (IUV) injection of oxytocin versus oxytocin IV infusion, 80 subjects were assigned to 2 groups according to the route of oxytocin. Primary outcome measures were duration of third stage of labor and amount of blood loss. Secondary outcome measures were the need for additional uterotonic agent, need for transfusion, uterine tone and acceptability to the examiner.

RESULTS: Blood loss was significantly lower in the IUV group compared to IV group (386.11±214.49 vs 516.22±139.95) while duration of third stage was longer in the IUV group (318±190.31 vs 271.49±200.60). The difference in hemoglobin pre and post-delivery is significantly lower in the UIV group (0.85±0.84 vs 1.29±1.13). Adequate uterine tone was achieved immediately after IUV oxytocin, thereby eliminating the need for Methylergometrine.

CONCLUSION: Intraumbilical vein injection of oxytocin in the active management of labor is an effective alternate route in preventing postpartum hemorrhage.

OBJECTIVE: To evaluate the efficacy of clinical use of a intrauterine Sengstaken-Blakemore tube (S-B tube) in postpartum hemorrhage not controlled with medication and conservative treatment. METHODS: Retrospective review was done in 18 women with insertion of S-B tube into intrauterine cavity who did not controlled with medication and conservative treatment for postpartum hemorrhage. After third stage of labor, women were treated with prophylactic intramuscular Methylergonovine 0.2 mg and intravenous infusions of oxytocin routinely. If the postpartum bleeding continued, Misoprostol 800 microgram (per rectal) and intravenous infusions of Dinoprost 2 mg mixed with 5% D/S 500 cc were employed. And then women were examined for retained placenta and laceration of birth canal. Where necessary, retained placenta was removed and lacerations were sutured. If the postpartum bleeding did not controlled despite all of procedures, we decided use of intrauterine S-B tube. RESULTS: The mean age of the patients was 30.9+/-4.4 (27-39) years, their mean body weights and parities were 67.8+/-8.2 (56.2-85.7) kg, 1.8+/-0.8 (1-4) and mean gestational age was 38.5+/-2.9 (37-42) weeks respectively. The mean time from delivery to insertion of S-B tube was 107.6+/-94.0 (24-360) minutes. The mean filled normal saline amount was 190.5+/-35.2 (120-230) cc. Of 18 who was inserted of S B tube, 15 cases needed not additional surgical therapy. So success rate was 83.3%. CONCLUSION: Insertion of intrauterine S-B tube appears as a simple and effective means of treating postpartum hemorrhage not controlled with medication and conservative treatment.
Body Weight ; Dinoprost ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infusions, Intravenous ; Lacerations ; Methylergonovine ; Misoprostol ; Oxytocin ; Parturition ; Placenta, Retained ; Postpartum Hemorrhage* ; Postpartum Period* ; Retrospective Studies

Uterine arteriovenous malformations are considered very rare conditions, potentially life-threatening lesions combined with various degrees of menorrhagia, postpartum bleeding, postmenopausal bleeding, an asymptomatic mass, and congestive heart failure. Clinical suspicion is essential for a prompt diagnosis and treatment. They may be diagnosed by gray-scale ultrasonography and Color Doppler imaging. Additionally, they can be detected using contrast material-enhanced computed tomography (CT), conventional angiography, hysteroscopy and hysterosalpingogram. More recently, diagnosis of uterine AVM with magnetic resonance imaging (MRI) has been reported. In the past, laparotomy with uterine artery ligation or hysterectomy was the only treatment available. However, successful conservative management with embolization of the affected vessels or methylergonovine maleate has been reported recently. A 37-year-old woman, gravida 3, para 1, presented with massive uterine bleeding that started abruptly four weeks after D and C. We promptly performed non-invasive diagnositic evaluations including color Doppler, MRI and MRA, with a clinical impression of uterine AVM. In this case, we describe the appropriate diagnosis and management of uterine AVMs with literatures.
Adult ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Heart Failure ; Hemorrhage ; Humans ; Hysterectomy ; Hysteroscopy ; Laparotomy ; Ligation ; Magnetic Resonance Imaging ; Menorrhagia ; Methylergonovine ; Postpartum Period ; Pregnancy* ; Ultrasonography ; Uterine Artery ; Uterine Hemorrhage*

BACKGROUND: Complaints of chest symptoms including pressure, tightness, or pain frequently occur during cesarean delivery under regional anesthesia. The aim of this study was to test whether methergine (methylergonovine maleate) aggravates chest symptoms and/or ECG changes during cesarean section under spinal anesthesia, and to determine if these changes are associated with any discernable intraoperative event. METHODS: After delivery, patients were given intravenous methergine 0.2 mg and diluted oxytocin 10 i.u. in 1000 ml Ringer's lactate solution (Methergine group, n = 30) or diluted oxytocin 20 i.u. (Control group, n = 29). ECG and hemodynamic responses were monitored continuously on 12 leads perioperatively. RESULTS: Methergine significantly increased the incidence of chest symptoms compared to the control group (30% vs. 3.4%, P < 0.05), but this increase was not correlated with ECG ST segment changes or with other intraoperative events. ECG changes suggestive of myocardial ischemia occurred in the two groups to similar extents (34.5% vs. 30%, P > 0.05). CONCLUSIONS: Methergine-induced chest symptoms per se do not signify evident myocardial ischemia during cesarean delivery. However, anesthesiologists must not overlook the possibility of a small coronary arteriolar spasm, especially in high-risk patients.
Anesthesia, Conduction ; Anesthesia, Spinal* ; Cesarean Section ; Electrocardiography* ; Female ; Hemodynamics ; Humans ; Incidence ; Lactic Acid ; Methylergonovine* ; Myocardial Ischemia ; Oxytocin ; Pregnancy ; Spasm ; Thorax*

OBJECTIVE: The purpose of our study is to find out the therapeutic effectiveness, reproductive outcome, and the diagnostic pathologic findings of the patients treated with resectoscopy. METHODS: We examined 110 patients who complained infertility, abnormal uterine bleeding and menorrhagia from May. 1995 to Dec. 2000 via office. Among the infertility and abnormal uterine bleeding patients with abnormal endometrial lesion, resectoscopy was performed and then the resected tissues was sended for pathologic examination, except IUA, uterine septum, and double uterus. After resectoscopy, we inserted Lippes loop and medicated premarin 2.5 mg, 54 days and medroxyprogesterone acetate 10 mg, 10 days to the IUA patients. In AUB patients, we only injected methergin for bleeding control. They visited office after 1 month, and the follow up for endometrial state was done through TVS, HSG, or hysteroscopy. RESULTS: Among the 44 infertility, 41 (93%) had normal endometrium findings. Of twenty pregnancy (48.8%), seven (35%) ended in a second trimester abortion, thirteen (65%) in a full-term infant. Among the 66 with abnormal uterine bleeding, the 62 (93%) had normal endometrial finding and normal menstruation pattern. But 2 patients recurred their symptom, then hysterectomy was done 3, 5 years later respectively. Most of the patients who performed histopathologic study were diagnosed as leiomyoma (59.4%), and then endometrial or endocervical polyp (25.3%) and residual placenta tissue (3.8%) respectively. CONCLUSION: The 101 patients (91.8%) improved their symptoms and intrauterine lesion. we suggest this technique which of diagnostic accuracy, cost safety, convenience, operation time, and patient's satisfaction.
Endometrium ; Estrogens, Conjugated (USP) ; Female ; Follow-Up Studies ; Gynecology* ; Hemorrhage ; Humans ; Hysterectomy ; Hysteroscopy ; Infant ; Infertility ; Leiomyoma ; Medroxyprogesterone Acetate ; Menorrhagia ; Menstruation ; Methylergonovine ; Placenta ; Polyps ; Pregnancy ; Pregnancy Trimester, Second ; Uterine Hemorrhage ; Uterus

Retained placenta around which the uterus firmly contracted occurs in about 1% of all vaginal deliveries and may require uterine muscle relaxation to facilitate manual extraction. It is associated with profuse hemorrhage and life threatening shock. Therefore anesthesiologist may face the difficulty to provide analgesia and rapid uterine relaxation. A 32-yr-old multigravida was transferred to the emergency room in hypovolemic shock state at 1 hour after vaginal delivery. Ketamine 30 mg, fentanyl 50 mcg were given intravenously for analgesia and sedation. Oxygen 6 L/min was supplied via face mask. With ongoing fluid resuscitation, nitroglycerin 500 mcg was injected as an intravenous bolus. Within 80 seconds, the uterus relaxed enough to extract the retained placenta. The recovery of uterine muscle tone occurred approximately 1 minute after manual removal with administration of intravenous methylergonovine. In summary, the use of intravenous nitroglycerin may be a useful and safe alternative to general anesthesia in cases of manual removal of retained placenta.
Analgesia ; Anesthesia, General ; Animals ; Emergency Service, Hospital ; Female ; Fentanyl ; Hemorrhage ; Ketamine ; Masks ; Methylergonovine ; Mice ; Myometrium ; Nitroglycerin* ; Oxygen ; Placenta, Retained* ; Relaxation ; Resuscitation ; Shock ; Uterus