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Misoprostol vs. Oxytocin for Postpartum Bleeding
Misoprostol may be an effective alternative for controlling postpartum hemorrhage in areas where the standard treatment, intravenous oxytocin, is not readily available, according to a noninferiority trial published online in Lancet.
In Ecuador, Egypt, and Vietnam, nearly 1000 women with postpartum hemorrhage and no prior oxytocin exposure were randomized to either intravenous oxytocin (40 IU) or sublingual misoprostol (800 µg), plus the corresponding placebo.
The rate of bleeding cessation 20 minutes after treatment was similar in the two groups (misoprostol: 90%, oxytocin: 96%). The authors say, however, that noninferiority "cannot be claimed."
They conclude: "Intravenous oxytocin should be used when available, but ... misoprostol could be an effective first-line treatment alternative when oxytocin is not available."
LINK(S):
Lancet article (Free abstract; full text requires subscription)
Published in Physician's First Watch January 11, 2010
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