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Misoprostol ile oksitosin ve metilergobasin maleat kullanımının doğumun üçüncü döneminin süresine ve kan kaybına olan etkilerinin karşılaştırılması

Amaç: Doğumun üçüncü döneminde kulla¬nılan 800 mcg misoprostol/PO ile 10 İÜ oksi¬tosin ve 200mcg metilergobasin maleat/IM'in doğumun üçüncü döneminin süresine ve ktrı kaybı üzerine olan etkilerinin karşılaştırılması. Yöntem ve Gereçler: Fırat Üniversitesi Tıp Fakültesi Kadın, Doğum Bölümüne başvuran 70 gebe randomize prospektif, tek kör çalışma programına alındı. Bebek doğurtulduktan sonra kord . klemplendi ve çalışma grubundakilere (Gl) 800 mcg/PO misoprostol, kontrol grubun-dakilere (G2) 10 İÜ oksitosin ve 200 mcg me¬tilergobasin -maleat intramuskuler uygulandı. Doğumun üçüncü dönemine ait özellikler (kan kaybı: Plasentanın doğumundan önce (mi), doğumundan sonra (mi)), üçüncü dönemin sü¬resi (dk), araştırıldı. Yan etkilerin değerlendi¬rilmesi için ateş, titreme, bulantı, kusma, ishal, tansiyon arteryel takibi kord klemplemesinden sonra 24 saat boyunca her saat bakıldı. Ateşin 38 °C nin üzerinde olması anlamlı kabul edildi (Ateş38 °C= İp) ve ayrıca titreme, bulantı, kusma, ishal ve tansiyon arter-yel değişiklikleri için (Sistolik > 150 mmHg; diastolik >100 mm Hg=lp, küçükse =0p) de nominal skala (yok=0p,var=lp) oluşturuldu. Bulgular: Altmış altı vakada çalışma ger¬çekleştirildi. Plasentanın doğumundan sonra görülen kan kaybı grup l'de 57±6 mi iken grup 2'de 161±87 mi, doğumun üçüncü döneminin süresi grup l'de 5.7±1.5 dk iken grup 2'de 18±5 dk bulundu (p=0.001, Student's t testi). Ateş grup l'de 33 vakada (%100) grup 2'de 4 vakada (%12) (RR=8, p=0.001, Fisher's exact test), titreme grup l'de 33 vakada (%100) grup 2'de 9 vakada (%27) görüldü (RR=3.7, p= 0.001, Fisher's exact test). Toplam kan kaybı grup l'de 31 vakada (%93) grup 2'de 23 vaka¬da (%70) 500 cc'nin altında idi (RR=1.3, p= 0.001, Fisher's exact test). Sonuç: Doğumun üçüncü döneminde 800 mcg/PO misoprostol kullanıldığında, doğumun üçüncü döneminin süresi, plasentanın doğu¬mundan sonraki kan kaybı 10IÜ oksitosin ve 200 mcg/EVI metilergobasin maleat'a göre an¬lamlı olarak azalır. Ateş ve titremede ise an¬lamlı artışa neden olur. Ancak gerek kan kay¬bını azaltması, gerekse depolanma ve uygula¬ma kolaylıkları nedeniyle oksitosin ve meterjin kullanımına seçenek olabilir

The comparison of the effects of mysoprostole or oxytosine and methylergobacine maleate administered in the third stage of labor on the duration of the stage and blood loss

Background.- The comparison of the effects of mysoprostole (800 mcg/PO) or oxytosine 10 IU/IM. plus methylergobacine maleate (200 mg/IM) administered in the third stage of labor on the duration of the stage and blood loss. Design.- Seventy pregnants admitted to department of Obstetrics and Gynecology were randomly selected to this prospective and single blind study program. Right after labor, umblical cord was clamped and mysoprostole 800 mcg/PO were administered to the individuals in the study group (group 1) and oxytosine 10 IU plus methylergobacine maleate 200 mcg/IM in the control group (group 2). The parameters relating the third stage blood loss before and after the delivery of placenta; the duration of third stage was monitored. The monitoring of the side effects has been done by checking body temperature, shivering, noisea . vomiting, diarrhea, blood pressure every hour for the first day after the cord was clamped. Body temperatures over 38 0C were accepted meaningful (38 0C=1p) and nominal scale was employed for the alterations in noisea . vomiting, diarrhea (absent=0p, present=1p) and blood pressure (systolic>150 mmHg, diastolic>100 mmHg=1p, if both below the given values=0p). Results.- Study was accomplished in 66 patients. Blood loss after the delivery of placenta was found to be 57±6 ml in group 1, whereas it was 161±87 ml in group 2 (p

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1. El-Refaey H, O'Brien P: Use of oral misoprostol in the prevention of postpartum haemorrhage. Br J Obstet.Gynaecol 1997; 104: 336-339. 2. McDonald S, Prendiville W, Blair E. Randomized controlled trial of oxytocin alone versus oxytosin and ergometrine in active management of third stage of labour. Br J Obstet Gynaecol 1993; 307: 1167-1171. 3. Poeschmann R.P, Doesburg W.H, Eskes T.K.A. Randomized comparison of oxytocin, sulprostone and plasebo in the management of the third stage of labour. Br J Obstet Gynaecol 1991; 98: 528-530. 4. Nordstöm L.Fogelstam K,Fridman G, Larsson A, Rydhstroem H. Routine oxytocin in the third stage of labounA plasebo controlled randomised trial. Br. J. Obstet. Gynaecol. 1997; 104: 781-786. 5. Prendiville W, Elbourne D, Chalmers I. The effect of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1988; 95: 3-16. 6. Beisner NA, Mackay EV. Obstetrics and the Newborn. London:Bailliere Tindall,1986: 169-177. 7. Prendiville W, Elburne D. Care during the third stage of labour. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective Care in Pregnancy and Childbirth.Oxford: Oxford University Press. 1989; 1145-1169. 8. Hogerzeil HV,Walker GJA; de Goeje MJ. Stability of injectable Oxytocics in Tropical Climates. Geneva:World Organization, 1993. 9. Kararlı TT, CatalanoT, Needham TE, Finnegan PM. Mechanism of misoprostol stabilization in hydroxpropyl methylcellulose. Adv. Exp. Med. Biol. 1991; 302: US- 10. Aubeny E, Baulieu EE. Activite contra gestivie de 1'association au RU486 D'une prostaglandine active par voie'oral. C R Acad Sci III 1991; 312: 539-546. 11. El-Rafaey H,Hinshaw K, Templeton A. The abortifacient effect of misoprostol in the second trimester. Hum. Reprod. 1993; 8: 1744-1746. 12. Karim A. Antiulcer prostoglandin misoprostol: single and multiple dose pharmacokinetic profile. Prostoglandins 1987; 33: 40-50. 13. Norman JE, Thong KJ, Baird DT. Uterine contractility and induction of abortion in early pregnancy by misoprostol and mifepristone.Lancet 1991; 338:1233- 1236. 14. Brecht T. Effects of misoprostol on human circulation. Prostoglandins 1987; 33: 51-59. 15. Pregnancy and childbirth Module. In: Keirse MJNC, Renfrew MJ,Neilson JP,Crowther c, editors. Cochrane Database of systematic Reviews. The Cochrane Collaboration, Issue 2. Oxford:Update software,1995:Review Nos 2974, 2999, 5352.
16. Prendiville Wl, Harding JE, Elbourne DR, Stirrat GM. The Bristol third stage trial: active versus physiological management of third stage of labour. Br J Obstet Gynaecol. 1988; 297: 1295-1300. 17. Thilaganathan B, Cuter A, Latimer J, Beard R. Management of the third stage of labour in women at low risk of postpartum haemmorrhage. Eur. J. Obstet Gynecol Reprod Biol 1993; 48: 19-22. 18. Ringrose CAD. The obstetrical use of ergot. Can Med. Assoc. J. 1962; 87: 712-714. 19. Browning DJ. Serious side effects of ergometrine and its use in routine obstetrics practice. Med. J. Austral 1974; 957-959. 20. Amant F, Bernard S, Timmerson D, Corremans A: Misoprostol compared with methylergometrine for the prevention of postpartum haemorrhage: adouble- blind randomised trial: Br J Obstet Gynaecol 1999; 106: 1066- 1070. 21. Hofmeyr GJ, Nikodem VC, De Jager M, Gelbart B. A randomised placebo controlled trial of oral misoprostol in the third stage of labour. Br J Obstet Gynaecol 1998; 105: 971-975. 22. Bamigboye AA, Hofmeyr J, Merrell DA. Rectal prevention of postpartum hemorrhage: A plasebo- controlled trial. Am J Obstet Gynecol 1998; 179: 1043- 1046 23. O'Brien P, EL-Rafaey H, Gordon A, Geary M, Rodeck CH: Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive stydy. Obstet Gynecol 1998; 92: 212-214. 24. Lumbiganon P, Hofmeyr J, Gülmezoğlu A M, Pinol A, Villar J. Misoprostol dose-related shivering and pyrexia in the third stage of labour. Br J Obstet Gyneacol 1999; 106: 304-308. 25. İnman WH. Report on curret PEM studies: Drugs for peptic ulcer or reflux. Prescription Event Monitoring News. 1991; 7:32-34. 26. Stobie-Hayes KM, Fewell JE. influence of pregnancy on the febrile response to intracerebroventricular administration of PGE1 in rats. J Appl Physiol 1996; 81: 1312-1315. 27. Jaameri K, Jahkola A, Perttu J. On shivering in association with normal delivery. Acta^Öbstet Gynecol Scand. 1966;45: 383-388.