misoprostol and Abruptio-Placentae

Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.

Topics: Abruptio Placentae; Antifibrinolytic Agents; Blood Transfusion; Cesarean Section; Crystalloid Solutions; Ergonovine; Female; Fluid Therapy; Gravity Suits; Health Facilities; Home Childbirth; Humans; Hysterectomy; Isotonic Solutions; Labor, Induced; Massage; Maternal Death; Misoprostol; Oxytocics; Oxytocin; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Tourniquets; Tranexamic Acid; Uterine Artery Embolization; Uterine Balloon Tamponade; Uterine Hemorrhage; Uterine Rupture

To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score.. This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-microg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed.. The mean time from induction to delivery was 9.36+/-1.97 hours in the misoprostol plus oxytocin group and 11.08+/-3.23 in the oxytocin alone group (P=0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia.. A 50-microg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.

Topics: Abruptio Placentae; Administration, Intravaginal; Adult; Apgar Score; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Time Factors

A 32-year-old multigravid patient at 21 weeks gestation presents with major concealed placental abruption and subsequent fetal demise. During an eventually failed misoprostol regime aiming for vaginal delivery she develops severe disseminated intravascular coagulopathy. Subsequent hysterotomy reveals Couvelaire uterus with major haemorrhage and requires subtotal hysterectomy for haemostasis. This case highlights the severity of the systemic response to abruption and fetal demise in utero and the multifactorial nature of its management.

Topics: Abortifacient Agents; Abruptio Placentae; Adult; Diagnosis, Differential; Disseminated Intravascular Coagulation; Female; Fetal Death; Humans; Hysterectomy; Misoprostol; Pregnancy; Pregnancy Trimester, Second

Recent data have raised concern about the safety of using misoprostol in women with preeclampsia. We wanted to evaluate the risk of placental abruption in women with preeclampsia undergoing cervical ripening with misoprostol compared to dinoprostone.. We evaluated data on 403 preeclamptic women receiving either misoprostol (N = 235) or dinoprostone (N = 168) at different regimens and delivering in two university hospitals in Switzerland (Geneva and Basel). The main outcome was the incidence of placental abruption in both groups using two definitions for placental abruption ("clinical" and "post hoc"). We performed univariable and multivariable analysis.. The overall incidence of placental abruption was 1.5% (six cases); 1.3% (3) in the misoprostol group versus 1.8% (3) in the dinoprostone group; p = 0.69). When using the post-hoc definition the incidence was higher in the latter group (1.3 versus 5.4%; p = 0.03). In multivariable analyses, the risk of placental abruption using the "post hoc" definition was associated with the use of dinoprostone.. The use of misoprotol in preeclamptic women appears to be safe and is not associated with a higher risk of placental abruption when compared with other prostaglandins. Concerns about the use of misoprostol in the case of preeclampsia are not justified.

Topics: Abruptio Placentae; Administration, Intravaginal; Adolescent; Adult; Cervical Ripening; Dinoprostone; Female; Humans; Incidence; Labor, Induced; Middle Aged; Misoprostol; Oxytocics; Pre-Eclampsia; Pregnancy; Prostaglandins; Risk; Young Adult

To evaluate complications associated with cervical ripening with vaginal administration of misoprostol and dinoprostone vaginal inserts in women with preeclampsia. preeclampsia.. Retrospective study of patients with preeclampsia undergoing cervical ripening with vaginal misoprostol and dinoprostone vaginal inserts prior to labor induction.. Among 203 patients with preeclampsia undergoing cervical ripening prior to induction, 95 received vaginal misoprostol, and 108 received dinoprostone. The incidence of uterine hyperstimulation requiring medical therapy and the need for emergency cesarean section due tofetal heart rate abnormalities were significantly higher among patients receiving misoprostol (22.1% versus 12.0%, p = 0.04, and 17.9% versus 8.3%, p = 0.03, respectively). The overall incidence of abruptio placentae was 7.4%, with a significantly higher incidence among those receiving misoprostol as compared to dinoprostone (13.7% versus 1.9%, p = 0.001).. Among patients with preeclampsia undergoing cervical ripening prior to labor induction, there is a higher incidence of acute intrapartum complications (uterine hyperstimulation, cesarean section for fetal heart rate abnormalities and abruptio placentae) with vaginal misoprostol, as compared to dinoprostone, vaginal insert.

Topics: Abruptio Placentae; Administration, Intravaginal; Adolescent; Adult; Apgar Score; Cervical Ripening; Cesarean Section; Delivery, Obstetric; Dinoprostone; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oliguria; Oxytocics; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pulmonary Edema; Retrospective Studies