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• W2526330037 abstract "Sir , We have read with great interest the article of Lokugamage et al. where they suggested that 800 µg of misoprostol per rectum is effective for treating primary postpartum hemorrhage. However, there are some gaps in this article. While the authors explained the experimental design, they failed to provide sufficient information on who did what regarding labor ward involvement with respect to estimation of blood loss, quickness in setting up, and rate of intravenous syntocinon infusion and data collection. These are the potential areas of bias in this study. Given that a misoprostol uterotonic effect can be noticed within 3 min and that it would have taken sometime to set up the syntocinon infusion, the authors were sensible to allow 20 min of drug activities before assessing drug efficacy and efficiency. The authors did not explain the method used to estimate blood loss. It is well known that blood loss estimation is notoriously inaccurate (1). Also it was estimated that it would take 2 years to complete the study in two hospitals with combined deliveries of 21 000 per year and a postpartum hemorrhage rate of 1%. This is equivalent to 210 cases per year. From their power calculation, 142 patients were to be recruited over a 2-year period. These did not add up. The results suggested there were no major differences in the side-effect profile of drugs in the two arms. This is in contrast to the studies carried out by Kundoyiwa et al. (2) and Chong et al. (3) where there were significant side-effects such as shivering, transient pyrexia, nausea, vomiting and diarrhea associated with doses of misoprostol at and greater than 400 µg, respectively. The authors deserve praise on their thoughtfulness in making it a randomized, single-blinded study for safety reasons as clearly stated in the article. Also they recognized that the strength of uterine contraction is not as important as the rate of cessation of hemorrhage. Lokugamage and his group also suggested that misoprostol appears to be better than syntometrine with a syntocinon infusion at treating postpartum hemorrhage when caused by uterine atony. Although, this is in agreement with previous studies by O'Brien et al. (2) and Chong et al. (4), Lokugamage might have reached a different conclusion if they used a higher concentration of syntocinon infusion, as 10 iu syntocinon in 500 ml of normal saline is very dilute. Given that misoprostol is cheap and thermostable, it has considerable potential to reduce maternal mortality from postpartum hemorrhage in developing countries. However, we would be interested to read the response of Lokugamage and his group to the gaps in the study." @default.
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• W2526330037 date "2002-10-01" @default.
• W2526330037 modified "2023-10-16" @default.
• W2526330037 title "Re: A randomized study comparing rectally administered misoprostol versus syntometrine combined with an oxytocin infusion for the cessation of primary postpartum hemorrhage" @default.
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• W2526330037 doi "https://doi.org/10.1034/j.1600-0412.2002.811019.x" @default.
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