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Wiley InterScience | ||||||||
  BJOG: An International Journal of Obstetrics & GynaecologyVolume 108 Issue 1, Pages 41 - 47 Published Online: 22 Dec 2003 Journal compilation © 2010 RCOG Published on behalf of the Royal College of Obstetricians and Gynaecologists
Abstract | References | Full Text: HTML, PDF (Size: 127K) | Related Articles | Citation Tracking  Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine Copyright RCOG 2003 BJOG: an International Journal of Obstetrics and Gynaecology ABSTRACTObjectives To investigate the effect of oral misoprostol in dosages varying from 200 μg to 800 μg on postpartum uterine contractility and to establish their side effects. Design A prospective descriptive study. Participants Fifty-seven women who delivered vaginally after spontaneous labours not requiring augmentation. Methods Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded. Results There was no statistical difference (P=0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 μg (adjusted mean difference –2282 kPas s, 95% CI –7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was significantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P=0.002), but their durations of action were similar (P=0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 38°C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women). Conclusion The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 μg to 400 μg , oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects. Accepted 6 September 2000 | 
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