阴道分娩中益母草注射液预防产后出血促进子宫收缩的多中心临床研究

目的:探讨益母草注射液在阴道分娩中预防产后出血和促进子宫复旧的有效性和安全性.方法:进行多中心、随机、单盲、阳性药物对照研究.2007年4～8月,全国15家三级医院联合进行448例病例研究,其中益母草组(A组)150例;益母草联合缩宫素组(B组)149例;缩宫素组(C组)149例.观察产后各时段子宫复旧情况、产时和产后阴道流血情况、产前产后血红蛋白、红细胞数的差值及药物副反应.结果:①产时和产后6小时时段A组缩宫效果不如B、C组,以后各时段比较无差异.②产后各时段比较,产后12小时时段A组阴道流血量较B、C组少(P0.05),其余时段阴道流血量差异无统计学意义.③3组产后24小时总出血量、产后出血发生率比较差异无统计学意义(P0.05).④各组产后红细胞数和血红蛋白值均都有不同程度的下降,但产前、产后的差值比较组问差异无统计学意义(P0.05);各组产后24小时出血量≥500ml的患者中A组产前、产后红细胞和血红蛋白差值显著低于B、C组(P0.05).⑤本研究中各组均未发生副反应.结论:益母草有缓慢但持续的缩宫效果,和缩宫素联合应用效果更好,药物安全性良好.     

益母草注射液在双胎妊娠剖宫产中的应用观察

目的:探讨益母草注射液在双胎妊娠剖宫产术中、术后出血的治疗效果。方法:选择2010年1月至2011年10月在海南医学院附属医院双胎妊娠剖宫产分娩的60例孕妇,随机分为两组。对照组(30例)术中宫体注射缩宫素,术后予肌内注射缩宫素。研究组(30例)术中益母草注射液与缩宫素联合使用,术后使用益母草注射液。比较两组术中出血量、术后<2小时、术后2～24小时的出血量及术后24小时总出血量和产后出血的发生率。结果:研究组术中出血量、术后<2小时出血量和术后24小时总出血量均少于对照组,差异有统计学意义(P<0.05);术后2～24小时的出血量和产后出血的发生率比较,差异均无统计学意义(P>0.05)。结论:术中益母草注射液与缩宫素联合应用可以减少双胎妊娠剖宫产中的出血,术后单独使用促宫缩效果良好,且具安全性。     

缩宫素联合益母草注射液对经阴道分娩和剖宫产产后出血的治疗效果分析

目的分析缩宫素联合益母草注射液对经阴道分娩和剖宫产产后出血的治疗效果。方法选取2017年2月~2019年5月我院经阴道分娩产妇50例,剖宫产产妇50例进行研究,随机抽签分为单一组和联合组,每组25例阴道分娩产妇和剖宫产产妇,分别给予缩宫素治疗和缩宫素联合益母草注射液治疗。结果联合组术后2 h、12 h、24 h出血量,均少于单一组产妇(P<0.05)。结论缩宫素联合益母草注射液治疗经阴道分娩和剖宫产产后出血效果突出,能有效增强产妇子宫收缩,减少出血量。     

米索前列醇预防剖宫产术后出血的临床观察

目的:探讨米索前列醇预防和治疗剖宫产术后出血的临床疗效。方法:选择384例剖宫产者随机分为三组,A组127例为术中口服米索前列醇600μg加宫体注射缩宫素20u、B组132例为术中宫体注射缩宫素20u再静脉滴注缩宫素10u,术后经直肠置入米素前列醇600ug;C组125例为术中宫体注射宿宫素20u再静脉注入10u,术后再静脉注入缩宫素20u。观察各组术中术后2小时出血量、24小时出血量、肛门恢复排气时间及副反应。结果:术中及术后2小时平均出血量,A组(145±42.4)ml,B组为(151士39.7)ml,C组(238±54.5)ml,术后24小时平均出血量,A组(204±61.5)ml,B组为(196±56.4)ml,C组(318±64.7)ml.米索前列醇配伍缩宫素组与单用缩宫素组比较,差异有显著性意义(P<0.05),口服米索前列醇组与直肠置药组比较,差异无显著性意义(P>0.05),但直肠置药组与口服药组比较,恢复肛门排气时间短,副反应轻。结论:米索前列醇与缩宫素配伍应用于剖宫产术中,能较好地预防剖宫产术后出血,直肠给药比口服给药副反应轻.用药方便安全。     

不同时间给予米索前列醇防治二次剖宫产产后出血

目的:探索米索前列醇不同时间给药防治二次剖宫产患者产后出血的临床效果。方法:将入选的126例二次剖宫产孕妇按照入院先后编号,随机分为三组:缩宫素组(A组,42例),术中、术后常规应用缩宫素;术后米索前列醇组(B组,41例),在A组基础上术后直肠放置米索前列醇;术中米索前列醇组(C组,43例),在A组基础上术中含服米索前列醇。比较三组患者术中、术后0~2h、术后3~24h出血量,产后出血发生率及产后出血控制措施。结果:C组患者术中、术后0~2h、术后3~24h出血量分别为(240.12±64.09)ml、(51.26±15.04)ml、(61.26±19.80)ml,均比A组出血量少(P0.05);C组患者术中和术后0~2h出血量显著低于B组(P0.05);B组患者术后0~2h、术后3~24h出血量显著低于A组(P0.05)。C组患者产后出血发生率为4.65%,显著低于A组(23.81%)(P0.05)。A组采取增加药物止血措施的比例为19.05%,显著高于C组(2.33%)(P0.05)。结论:术中含服米索前列醇联合缩宫素防治二次剖宫产产后出血较术后给予米索前列醇和单纯缩宫素给药临床效果好。     

宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效观察

目的:探讨宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效。方法:有剖宫产产后出血高危因素产妇125例,随机分为A组(n=63)和B组(n=62)。A、B组所有患者均于胎儿娩出后给予子宫壁肌肉内注射缩宫素20 U、静脉滴注缩宫素10 U,手术结束后给予肛塞米索前列醇400μg。但A组另于胎盘娩出、宫腔清理后给予纱布填塞宫腔。观察术中、术后2 h、术后24 h出血量及手术时间、产褥感染、不良反应情况。结果:A组术中、术后2 h、术后24 h出血量分别为:150.3±42.3 ml,282.2±55.2 ml,355.8±92.5 ml;产后出血率为1.59%;B组术中、术后2 h、术后24 h出血量分别为:206.7±33.9 ml,456.2±75.3 ml,568.4±83.2 m1;产后出血率为12.90%;A组出血量及产后出血发生率明显低于B组(P0.05),而手术时间、产褥感染、不良反应情况组间无统计学差异(P0.05)。结论:宫腔填塞纱布联合米索前列醇预防高危因素剖宫产产后出血疗效显著,可明显减少产后出血发生率。     

卡孕栓与缩宫素合用预防产后出血的临床观察

目的:观察卡孕栓对足月阴道分娩产后出血的影响。方法:选择正常足月非高危妊娠100例分成两组:对照组50例在胎儿娩出后立即静脉注射缩宫素10U,实验组50例在胎儿娩出后立即静脉注射缩宫素10U另加直肠加置卡孕栓1枚(500ug)(东北制药总厂500ug/粒),容积法和称重法观察产后2小时和24小时出血量。结果产后2小时及24小时出血量对照组为(220.6±66.8)ml、(318.5±108.7)ml。实验组为(180.6±42.5)ml、(236.5±56.9)ml;实验组与对照组相比,差异有显著(P<0.05)。卡孕栓与缩宫素合用是预防产后出血的发生、降低因产后出血的有效措施。     

第三产程产后出血防治措施的分析

目的 :探讨第三产程产后出血的防治措施。方法 :前瞻性观察我院住院分娩的产妇 45 0例 ,其中阴道分娩30 0例 ,随机分为 5组。A组 :缩宫素组 (6 0例 ) ,于胎儿娩出后静脉推注生理盐水 2 0ml加缩宫素 2 0U ;B组 :卡前列甲酯组 (6 0例 ) ,于胎儿娩出后将卡前列甲酯 1mg塞肛 ;C组 :手法按摩组 (6 0例 ) ,胎儿娩出后手法持续宫底按摩≥ 5分钟 ,适度牵拉脐带 ;D组 :缩宫素加手法按摩组 (6 0例 ) ;对照组 (6 0例 ) :于胎儿娩出后静脉滴注生理盐水 5 0 0ml。另 15 0例剖宫产分娩者 ,随机分为 3组 ,A组 :缩宫素组 (5 0例 ) ;B组 :手法组 (5 0例 ) ;C组 :缩宫素加手法组 (5 0例 )。准确测量产后 2小时及 2 4小时出血量 ,记录第三产程时间。结果 :阴道分娩各组中 ,D组的第三产程时间最短 ,产后 2小时内出血量最少 ,C组、B组、A组依次减少 ;剖宫产各组中 ,C组的产后出血量及产后出血发生率与A组、B组相比 ,差异有显著性 ;剖宫产组产后出血量与阴道分娩组比较 ,其差异也有统计学意义。结论 :胎儿娩出后及时使用缩宫素或卡前列甲酯等促宫缩药 ,并采取主动手法辅助娩出胎盘 ,可减少产后出血 ,其预防产后出血的效果显著优于上述其他处理方法。     

卡前列素防治高危产妇剖宫产术中及术后出血的临床研究

目的观察卡前列素治疗有出血高危因素的产妇剖宫产术中、术后出血的有效性和安全性。方法对469例有出血高危因素（包括双胎、羊水过多、巨大儿、前置胎盘）的产妇行计划性剖宫产术。其中巨大儿239例,双胎＋羊水过多145例,前置胎盘73例。术中胎儿娩出后随机按宫缩剂使用情况分为3组,缩宫素组152例,缩宫素20U于宫体注射,另20U加入液体中静脉滴人;缩宫素＋卡前列素组192例,缩宫素20U＋卡前列素250txg宫体注射;卡前列素组125例,卡前列素250嵋于宫体注射。计算3组术中、术后2h出血量及总出血量,并观察3组的副反应。结果（1）3组产妇术中出血量分别为,缩宫素组（445±262）m1,缩宫素＋卡前列素组（332±218）m1,卡前列素组（375±265）m1,缩宫素组分别与缩宫素＋卡前列素组和卡前列素组比较,差异有统计学意义（P〈0．01,P〈0．01）。（2）3组产妇术后2h出血量分别为,缩宫素组（176±193）m1,缩宫素＋卡前列素组（110±114）m1,卡前列素组（124±103）m1,缩宫素组分别与缩宫素＋卡前列素组和卡前列素组比较,差异有统计学意义（P〈0．01,P〈0．01）,缩宫素＋卡前列素组与卡前列素组比较,差异无统计学意义（P〉0．05）。（3）3组产妇中,总出血量≥1000ml共31例,其中缩宫素组15例（48％）,缩宫素＋卡前列素组7例（23％）,卡前列素组9例（29％）。（4）3组不同高危因素产妇出血量比较：缩宫素组中巨大儿产妇总出血量明显多于缩宫素＋卡前列素组和卡前列素组（P〈0．01,P〈0．01）;缩宫素组中双胎＋羊水过多产妇术后2h出血量明显多于缩宫素＋卡前列素组和卡前列素组（P〈0．01,P〈0．01）;缩宫素组中前置胎盘产妇术后2h出血量明显多于缩宫素＋卡前列素组（P〈0．01）。（5）总出血量≥1000ml的巨大儿产妇12例,双胎产妇11例,前置胎盘产妇8例,无一例切除子宫。（6）副反应发生率缩宫素组为2．6％（4／152）,缩宫素＋卡前列素组为11．5％（22／192）,卡前列素组为7．0％（9／125）,后两组以呕吐为常见,短时间好转。结论卡前列素用于有出血高危因素产妇的剖宫产术可明显减少术中、术后出血量,与缩宫素联合应用效果更好。     

米索前列醇在有高危出血因素剖宫产术中的应用

目的:观察米索前列醇用于有高危出血因素剖宫产者预防产后出血的效果.方法:选择有产后出血高危因素剖宫产者68例,随机分为观察组及对照组,观察组38例,胎儿娩出后宫体注射缩宫素20 U、静脉注射缩宫素20 U,同时术中口服米索前列醇.对照组30例,胎儿娩出后宫体注射缩宫素20 U,再静脉注射缩宫素20 U.观察两组术中及术后2小时内出血量.结果:观察组术中及术后2小时平均出血量252 4±56 ml,与对照组358±63 ml比较,差异有高度统计学意义(P<0.01).两组患者血压、血氧饱和度、心率的影响比较,差异无统计学意义(P>0.05).结论:在常规使用缩宫素的同时,采用术中口服米索前列醇,预防有高危出血因素的患者剖宫产术后出血临床效果较好,且用药方便、安全.     

Combination of motherwort injection and oxytocin for the prevention of postpartum hemorrhage after cesarean section

Objective: To evaluate the efficacy and safety of motherwort injection combined with oxytocin for preventing postpartum hemorrhage (PPH) after cesarean section (CS).

Methods: From March 2011 and February 2013, a randomized study was conducted on 165 primipara undergoing CS. 83 and 82 cases were placed into the combination of oxytocin and motherwort group and oxytocin group, respectively. Blood loss was calculated and measured during three periods: from placental delivery to the end of CS, from the end of CS to 2?h postpartum and from 2?h postpartum to 24?h postpartum. Vital signs were also measured.

Results: Blood loss in the period from placental delivery to the end of CS was similar (P?=?0.58) in these two arms. The quantity of total blood loss from the end of CS to 2?h postpartum (P?=?0.03) and from 2?h postpartum to 24?h postpartum (P?=?0.01) were significantly reduced in the combination of oxytocin and motherwort group. No significant abnormal vital signs were observed. Mild, transient side effects occurred more often in the combination of oxytocin and motherwort group.

Conclusions: It is efficacious and safe that combination use of motherwort injection and oxytocin could reduce blood loss and prevent PPH after CS.     

Efficacy of tranexamic acid in reducing blood loss after cesarean section

Aim. To assess the efficacy and safety of tranexamic acid in reducing blood loss at caesarian section (CS).

Method. A prospective randomised study conducted on 90 primiparas divided into two groups who underwent CS. The study group, 45 women, received tranexamic acid immediately before CS, whereas the control group, 45 women received placebo. Blood loss volume was measured from the end of CS to 2 h postpartum and compared between the two groups. Hemoglobin (Hb) and hematocrit (Hct) were tested 24 h after CS and compared between the two groups.

Results. Tranexamic acid significantly reduced the blood loss from the end of CS to 2 h postpartum; 28.02 ± 5.53 mL in the tranexamic group versus 37.12 ± 8.97 mL in the control group (p = 0.000). Hb 24 h after CS was significantly greater in tranexamic group than control group (12.57 ± 1.33 in the tranexamic group and 11.74 ± 1.14 in the control group, p = 0.002). No complications or side effects were reported in either group.

Conclusions. Tranexamic acid statistically reduces blood loss from end to 2 h after CS and its use was not associated with any side effects or complications. Consequently, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.     

Routine oxytocin in the third stage of labour: a placebo controlled randomised trial

Objective To compare intravenous oxytocin administration (Partocon® 10 IU) with saline solution in the management of postpartum haemorrhage in the third stage of labour.
Design A double-blind, randomised controlled trial involving 1000 parturients with singleton fetuses in cephalic presentation and undergoing vaginal delivery, randomly allocated to treatment with oxytocin ( n =513) or 0.9% saline solution ( n =487).
Setting Labour ward at a central county hospital.
Main outcome measures Mean blood loss (total, and before and after placenta delivery); frequencies of blood loss > 800 mL, need of additional oxytocic treatment, postpartum haemoglobin < 10 g/dL; and duration of postpartum hospitalisation.
Results As compared with saline solution, oxytocin administration was associated with significant reduction in mean total blood loss (407 versus 527 mL), and in frequencies of postpartum haemorrhage > 800 mL (8.8% versus 15.2%), additional treatment with metylergometrine (7.8% versus 13.8%), and postpartum Hb < 10 g/dL (9.7% versus 15.2%), and a nonsignificant increase in the frequency of manual placenta removal (3.5% versus 2.3%). There was no group difference in the mean duration of postpartum hospitalisation (4.6 versus 4.5 days, respectively).
Conclusions Administration of intravenous oxytocin in the third stage of labour is associated with an approximately 22% reduction in mean blood loss, and approximately 40% reductions in frequencies of postpartum haemorrhage (> 500 mL or >800 mL) and of postpartum haemoglobin < 10 g/dL. Identification of risk groups for oxytocin treatment does not seem worthwhile. Oxytocin is a cheap atoxic drug and should be given routinely after vaginal delivery.     

Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor

OBJECTIVES: To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. METHODS: A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15-month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss >500 ml, and need of additional uterotonic treatment were evaluated. RESULTS: As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss >500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11-0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11-0.85). CONCLUSIONS: Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor.     

Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery

Objective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).

Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10?mg/kg TA intravenously 5?min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1?ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2?h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.

Results: TA group showed lower amount of blood loss (391?ml) when compared to control group (597?ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day.

Conclusion: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.     

A comparison of the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries for different indications

Objective

To compare the efficacy of carbetocin and oxytocin on hemorrhage-related changes in women with cesarean deliveries (CS) for different indications.

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).

Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30?IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.

Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p?=?.06 and 0.24 respectively) and hematocrit values (p?=?.12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7?±?90.6 versus 588.9?±?96.3?mL respectively, p?=?.001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p?=?.002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.

Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.     

A randomized comparison of oxytocin, sulprostone and placebo in the management of the third stage of labour

OBJECTIVE--To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage. DESIGN--Randomized, placebo controlled, double-blind trial. SETTING--Radboud University Hospital, Nijmegen (67 women) and Lievensberg Hospital, Bergen op Zoom (10 women). PARTICIPANTS--77 women entered the trial (three were excluded). INTERVENTIONS--The intramuscular injection, immediately after the birth of the baby, of either oxytocin 5 IU, sulprostone 500 micrograms or 0.9% saline. MAIN OUTCOME MEASURES--Quantitative postpartum blood loss and length of third stage. RESULTS--Postpartum blood loss was reduced almost equally, by about 35%, by oxytocin (P = 0.02), or sulprostone (P = 0.05). The mean length of the third stage was shorter in both groups receiving the active treatment, this effect was significant in the sulprostone group (P = 0.01). CONCLUSION--Prophylactic administration of oxytocin or sulprostone directly after delivery followed by expectant management of the third stage reduces post partum blood loss and shortens the third stage.     

New insights into fatigue and health-related quality of life after delivery

BACKGROUND: A delivery has a major impact on the health-related quality of life (HRQoL) of the new mother, especially on fatigue. A common complication during delivery that might have a relationship with maternal morbidity is blood loss. The objectives were to investigate fatigue and HRQoL in women after vaginal delivery (VD), elective caesarean section (CS) and emergency CS, and its relationship with postpartum hemoglobin (Hb) levels during the first 6 weeks postpartum. METHODS: Some 141 patients (71 after VD, 36 after elective CS and 34 after emergency CS) completed the HRQoL questionnaires MFI and EQ-5D between 12 and 24 h after VD and 24-48 h after CS (t=0). At 1, 3 and 6 weeks postpartum these questionnaires were repeated, together with the SF36. RESULTS: Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and >6 weeks after emergency CS. Mean mental HRQoL scores of the study groups were similar or even better compared to reference values. The significant correlation between Hb level and mean physical HRQoL scores found at t=0 had disappeared at 1 week postpartum. CONCLUSIONS: Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.     

Misoprostol versus oxytocin for the reduction of postpartum blood loss.

OBJECTIVE: To compare the effect of 400 mug of oral misoprostol with 5 U of intravenous oxytocin in the reduction of postpartum blood loss and prevention of postpartum hemorrhage. METHODS: In a prospective, double-blind, randomized controlled trial conducted in a tertiary maternity hospital 622 women received either 400 mug of oral misoprostol or 5 U of intravenous oxytocin after delivery of the anterior shoulder or within 1 min of delivery. The primary outcome was a hematocrit drop of 10% or greater 24 h postpartum. The secondary outcomes were a hemoglobin drop of 30 mg/L or greater, the use of additional oxytocin, an estimated blood loss greater than 1000 mL, manual removal of the placenta, a blood transfusion, and shivering and fever (>or=38 degrees C) as adverse effects of misoprostol. RESULTS: There was no difference between the 2 groups regarding the primary outcome (a >or=10% hematocrit drop occurred in 3.4% and 3.7% of the participants in the oxytocin and misoprostol groups, P=0.98). The rate of use of additional oxytocin was higher in the misoprostol group (51% versus 40.5%, P=0.01). Shivering was confined to the misoprostol group (6.8%), and fever occurred in 12.5% of the women in the misoprostol group and 0.3% of the women in the oxytocin group. CONCLUSION: The routine use of 400 microg of oral misoprostol was no less effective than 5 U of intravenous oxytocin in reducing blood loss after delivery, as assessed by change in postpartum hematocrit. The adverse effects of misoprostol were mild and self-limiting.