Venture Strategies: Overview of Misoprostol studies in Postpartum Hemorrhage

Publication date: 2006

19 OVERVIEW OF MISOPROSTOL STUDIES IN POSTPARTUM HEMORRHAGE A. Hemmerling INTRODUCTION These tables of peer-reviewed misoprostol studies were compiled to provide the reader with comprehensive references to the use of misoprostol in practice since 1997, for both prevention and treatment of postpartum hemor- rhage. The tables include both randomized and non-randomized trials, and they represent a diversity of situations. Table 1 provides an overview of 32 studies in the prevention of postpartum hemorrhage (including dosage and route of administration). Table 2 gives an overview of seven studies in the treatment of postpartum hemorrhage (including dosage and route of administration). 162 184 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 15:04:27 Color profile: Generic CMYK printer profile Composite Default screen 163 Overview of misoprostol studies in postpartum hemorrhage A ut ho rs In st itu tio ns S tu dy tit le Jo ur na l n P ar tic ip an ts in m is op ro st ol gr ou p D os ag e of m is op ro st ol R ou te of ad m in is tr at io n P ar tic ip an ts in co nt ro l gr ou p( s) C on tr ol ag en t( s) P ra ta N , H am za S , G yp so n R ,e ta l. B ix by P ro gr am in P op ul at io n, F am ily P la nn in g an d M at er na l H ea lt h, S ch oo lo f P ub lic H ea lt h, U ni ve rs it y of C al if or ni a, B er ke le y, U S A M is op ro st ol an d ac ti ve m an ag em en t of th e th ir d st ag e of la bo r In tJ G yn ae co l O bs te t2 00 6 Ju l6 [e pu b ah ea d of pr in t] 8 25 32 11 89 60 0 µg or al 13 43 cu rr en t A M T S L pr ac ti ce s N el lo re V , M it ta lS , D ad hw al V D ep t. of O bs te tr ic s an d G yn ec ol og y, A ll In di a In st it ut e of M ed ic al S ci en ce s, A ns ar iN ag ar , N ew D el hi ,I nd ia R ec ta lm is op ro st ol vs . 15 -m et hy lp ro st ag la nd in F 2α fo r th e pr ev en ti on of P P H In tJ G yn ae co l O bs te t2 00 6; 94 :4 5– 6 8 12 0 60 40 0 µg re ct al 60 12 5 µg 15 -m et hy l pr os ta gl an di n F 2α i.m . C ha nd hi ok N , D hi llo n B S , D at ey S ,e ta l. D iv is io n of R ep ro du ct iv e H ea lt h an d N ut ri ti on , In di an C ou nc il of M ed ic al R es ea rc h, N ew D el hi ,I nd ia O ra lm is op ro st ol fo r pr ev en ti on of P P H by pa ra m ed ic al w or ke rs in In di a In tJ G yn ae co l O bs te t2 00 6; 92 :1 70 –5 8 12 00 60 0 60 0 µg or al 60 0 cu rr en t go ve rn m en t gu id el in es fo r P P H pr ev en ti on Z ac ha ri ah E S , N ai du M , S es ha dr iL D ep t. of O bs te tr ic s an d G yn ec ol og y, C hr is ti an M ed ic al C ol le ge H os pi ta l V el lo re ,I nd ia O ra lm is op ro st ol in th e th ir d st ag e of la bo r In tJ G yn ae co l O bs te t2 00 6; 92 :2 3– 6 8 20 23 73 0 40 0 µg or al [1 ] 61 7 [2 ] 67 6 [1 ] 10 IU ox yt oc in i.m . [2 ] 2 m g er go m et ri ne i.v . G ar g P , B at ra S , G an dh iG M au la na A za d M ed ic al C ol le ge an d L ok N ay ak H os pi ta l, D el hi ,I nd ia O ra lm is op ro st ol vs .i nj ec ta bl e m et hy le rg om et ri ne in m an ag em en t of th e th ir d st ag e of la bo r In tJ G yn ae co l O bs te t2 00 5; 91 :1 60 –1 8 20 0 10 0 60 0 µg or al 10 0 0. 2 m g m et hy le rg om et ri ne i.v . O zk ay a O , S ez ik M , K ay a H ,e ta l. D ep t. of O bs te tr ic s an d G yn ec ol og y, S ch oo lo f M ed ic in e, S ul ey m an D em ir el U ni ve rs it y, T ur ke y P la ce bo -c on tr ol le d ra nd om iz ed co m pa ri so n of va gi na lw it h re ct al m is op ro st ol in th e pr ev en ti on of P P H J O bs te t G yn ae co lR es 20 05 ;3 1: 38 9– 93 8 15 0 [1 ] 50 [2 ] 50 40 0 µg [1 ] re ct al [2 ] or al 50 pl ac eb o H oj L , C ar do so P , N ie ls en B B , et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, A ar hu s U ni ve rs it y H os pi ta l, D en m ar k E ff ec t of su bl in gu al m is op ro st ol on se ve re P P H in a pr im ar y he al th ce nt er in G ui ne a- B is sa u: ra nd om iz ed do ub le -b lin d cl in ic al tr ia l B M J 20 05 ; 33 1: 72 3 8 66 1 33 0 60 0 µg su bl in gu al 33 1 pl ac eb o C on tin ue d T ab le 1 M is op ro st ol fo r pr ev en ti on 185 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:36 Color profile: Generic CMYK printer profile Composite Default screen 164 POSTPARTUM HEMORRHAGE A ut ho rs In st itu tio ns S tu dy tit le Jo ur na l n P ar tic ip an ts in m is op ro st ol gr ou p D os ag e of m is op ro st ol R ou te of ad m in is tr at io n P ar tic ip an ts in co nt ro l gr ou p( s) C on tr ol ag en t( s) W al ra ve n G , B lu m J, D am ph a Y , et al . F ar af en ni F ie ld S ta ti on , M ed ic al R es ea rc h C ou nc il L ab or at or ie s, F ar af en ni ,G am bi a M is op ro st ol in th e m an ag em en t of th e th ir d st ag e of la bo r in th e ho m e de liv er y se tt in g in ru ra lG am bi a: a ra nd om iz ed co nt ro lle d tr ia l B JO G 20 05 ; 11 2: 12 77 –8 3 8 12 29 63 0 60 0 µg or al 59 9 2 m g er go m et ri ne or al V im al a N , M it ta lS , K um ar S , et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, A ll In di a In st it ut e of M ed ic al S ci en ce s, A ns ar iN ag ar ,N ew D el hi , In di a S ub lin gu al m is op ro st ol ve rs us m et hy le rg om et ri ne fo r ac ti ve m an ag em en t of th e th ir d st ag e of la bo r In tJ G yn ae co l O bs te t2 00 4; 87 :1 –5 8 12 0 60 40 0 µg su bl in gu al 60 0. 2 m g m et hy le rg om et ri ne i.v . L am H ,T an g O S ,L ee C P , et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, Q ue en M ar y H os pi ta l, H on g K on g S A R , C hi na A pi lo t- ra nd om iz ed co m pa ri so n of su bl in gu al m is op ro st ol w it h sy nt om et ri ne on th e bl oo d lo ss in th ir d st ag e of la bo r A ct a O bs te t G yn ec ol S ca nd 20 04 ;8 3: 64 7– 50 8 60 30 60 0 µg su bl in gu al 30 1 m ls yn to m et ri ne i.v .( 5 IU sy nt oc in on e an d 0. 5 m g er go m et ri ne m al ea te ) C al is ka n E , D ilb az B , M ey da nl iM M , et al . S S K M at er ni ty an d W om en ’s H ea lt h T ea ch in g H os pi ta l, A nk ar a, T ur ke y O ra lm is op ro st ol fo r th e th ir d st ag e of la bo r: a ra nd om iz ed co nt ro lle d tr ia l O bs te tG yn ec ol 20 03 ;1 01 : 92 1– 8 8 15 74 38 8 60 0 µg or al [1 ] 40 4 [2 ] 38 4 [3 ] 39 8 [1 ] 60 0 µg m is op ro st ol pl us 10 IU ox yt oc in i.v . [2 ] 10 IU ox yt oc in i.v . [3 ] 10 IU ox yt oc in i.v .p lu s 0. 2 m g m et hy le rg on ov in e m al ea te O bo ro V O , T ab ow ei T O M at er ni ty U ni t, Z on al G en er al H os pi ta l, K w al e, D el ta S ta te ,N ig er ia A ra nd om iz ed co nt ro lle d tr ia l of m is op ro st ol vs .o xy to ci n in th e ac ti ve m an ag em en t of th e th ir d st ag e of la bo r O bs te tG yn ec ol 20 03 ;2 3: 13 –1 6 8 49 6 24 7 60 0 µg or al 24 9 10 IU ox yt oc in i.m . L um bi ga no n P , V ill ar J, P ia gg io G ,e ta l. D ep t. of O bs te tr ic s an d G yn ec ol og y, F ac ul ty of M ed ic in e, K ho n K ae n U ni ve rs it y, T ha ila nd S id e- ef fe ct s of or al m is op ro st ol du ri ng th e fir st 24 h af te r ad m in is tr at io n in th e th ir d st ag e of la bo r B JO G 20 02 ;1 09 : 12 22 –6 8 16 86 84 3 60 0 µg or al 84 3 10 IU ox yt oc in i.m . or i.v . T ab le 1 C on tin ue d 186 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:36 Color profile: Generic CMYK printer profile Composite Default screen 165 Overview of misoprostol studies in postpartum hemorrhage Q ui ro ga D ia z R ,E sp ar az a A re ch ig a M , B at iz a R es en di z V ,e ta l. H os pi ta ld e G in ec ol og ia y O bs te tr ic ia de M on te rr ey , N .L .M ex ic o V ag in al m is op ro st ol in th e pr ev en ti on of P P H G in ec ol O bs te t M ex 20 02 ;7 0: 57 2– 5 8 40 0 20 8 80 0 µg va gi na l 19 2 cu rr en t A M T S L pr ac ti ce s C al is ka n E , M ey da nl iM M , D ilb az B ,e ta l. S oc ia lS ec ur it y C ou nc il: M at er ni ty an d W om en ’s H ea lt h T ea ch in g H os pi ta l, K uc uk es at ,A nk ar a, T ur ke y Is re ct al m is op ro st ol re al ly ef fe ct iv e in th e tr ea tm en t of th ir d st ag e of la bo r? A ra nd om iz ed co nt ro lle d tr ia l A m J O bs te t G yn ec ol 20 02 ; 18 7: 10 38 –4 5 8 16 06 39 6 60 0 µg re ct al [1 ] 40 1 [2 ] 40 7 [3 ] 40 2 [1 ] 10 IU ox yt oc in i.v .p lu s 60 0 µg m is op ro st ol re ct al [2 ] 10 IU ox yt oc in i.v . [3 ] 10 IU ox yt oc in i.v .p lu s 1 m l m et hy le rg om et ri ne i.m . K ar ka ni s S G , C al oi a D , S al en ie ks M E , et al . U ni ve rs it y of T or on to , T or on to ,C an ad a R an do m iz ed co nt ro lle d tr ia l of re ct al m is op ro st ol vs . ox yt oc in in th ir d st ag e m an ag em en t J O bs te t G yn ae co lC an 20 02 ;2 4: 14 9– 54 8 21 4 11 0 40 0 µg re ct al 11 3 5 IU ox yt oc in i.v . or 10 IU ox yt oc in i.m . K un do dy iw a T W ,M aj ok o F , R us ak an ik o S D ep t. of O bs te tr ic s an d G yn ec ol og y, U ni ve rs it y of Z im ba bw e, H ar ar e, Z im ba bw e M is op ro st ol vs .o xy to ci n in th e th ir d st ag e of la bo r In tJ G yn ae co l O bs te t2 00 1; 75 :2 35 –4 1 8 49 9 24 3 40 0 µg or al 25 6 10 IU ox yt oc in i.m . B en ch im ol M , G on dr y J, M en ti on JE , et al . C en tr e de G yn ec ol og ie O bs te tr iq ue ,A m ie ns , F ra nc e R ol e of m is op ro st ol in th e de liv er y ou tc om e J G yn ec ol O bs te tB io l R ep ro d (P ar is ) 20 01 ;3 0: 57 6– 83 8 60 0 20 0 60 0 µg or al [1 ] 20 0 [2 ] 20 0 [1 ] 2. 5 IU ox yt oc in i.v . [2 ] pl ac eb o G er st en fe ld T S , W in g D A W om en ’s an d C hi ld re n’ s H os pi ta l, D ep t. of O bs te tr ic s an d G yn ec ol og y, U ni ve rs it y of S ou th er n C al if or ni a K ec k S ch oo lo f M ed ic in e, L os A ng el es ,U S A R ec ta lm is op ro st ol vs . in tr av en ou s ox yt oc in fo r th e pr ev en ti on of P P H af te r va gi na ld el iv er y A m J O bs te t G yn ec ol 20 01 ; 18 5: 87 8– 82 8 32 5 15 9 40 0 µg re ct al 16 6 20 IU ox yt oc in i.v . G ul m ez og lu A M ,V ill ar J, N go c N T ,e ta l. W H O C ol la bo ra ti ve G ro up to E va lu at e M is op ro st ol in th e M an ag em en t of th e T hi rd S ta ge of L ab ou r W H O m ul ti ce nt er ra nd om iz ed tr ia lo f m is op ro st ol in th e m an ag em en t of th e th ir d st ag e of la bo r L an ce t2 00 1; 35 8: 68 9– 95 18 53 0 92 64 60 0 µg or al 92 66 10 IU ox yt oc in i.m . or i.v . C on tin ue d 187 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:36 Color profile: Generic CMYK printer profile Composite Default screen 166 POSTPARTUM HEMORRHAGE A ut ho rs In st itu tio ns S tu dy tit le Jo ur na l n P ar tic ip an ts in m is op ro st ol gr ou p D os ag e of m is op ro st ol R ou te of ad m in is tr at io n P ar tic ip an ts in co nt ro l gr ou p( s) C on tr ol ag en t( s) H of m ey r G J, N ik od em V C , de Ja ge r M , et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, C or on at io n H os pi ta la nd E ff ec ti ve C ar e R es ea rc h U ni t, U ni ve rs it y of th e W it w at er sr an d, Jo ha nn es bu rg ,S ou th A fr ic a S id e- ef fe ct s of or al m is op ro st ol in th e th ir d st ag e of la bo r – a ra nd om iz ed pl ac eb o- co nt ro lle d tr ia l S A fr M ed J 20 01 ;9 1: 43 2– 5 8 60 0 30 0 60 0 µg or al 30 0 pl ac eb o B ug al ho A , D an ie lA , F au nd es A , et al . M at er ni ty of th e H os pi ta l C en tr al de M ap ut o, M ap ut o, M oz am bi qu e M is op ro st ol fo r pr ev en ti on of P P H In tJ G yn ae co l O bs te t2 00 1; 73 :1 –6 8 66 3 32 4 40 0 µg re ct al 33 9 10 IU ox yt oc in i.m . N g P S ,C ha n A S ,S in W K , et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, T he C hi ne se U ni ve rs it y of H on g K on g, P ri nc e of W al es H os pi ta l, S ha ti n, N ew T er ri to ri es A m ul ti ce nt er ra nd om iz ed co nt ro lle d tr ia lo f or al m is op ro st ol an d i.m sy nt om et ri ne in th e m an ag em en t of th e th ir d st ag e of la bo r H um R ep ro d 20 01 ;1 6: 31 –5 8 20 58 10 26 60 0 µg or al 10 32 1 m ls yn to m et ri ne i.v .( 5 IU sy nt oc in on e an d 0. 5 m g er go m et ri ne m al ea te 0. 5 m g) W al le y R L , W ils on JB , C ra ne JM ,e ta l. D ep t. of O bs te tr ic s an d G yn ae co lo gy ,S t Jo hn ’s , M em or ia lU ni ve rs it y of N ew fo un dl an d, C an ad a A do ub le -b lin d pl ac eb o co nt ro lle d ra nd om iz ed tr ia l of m is op ro st ol an d ox yt oc in in th e m an ag em en t of th e th ir d st ag e of la bo r B JO G 20 00 ; 10 7: 11 11 –1 5 8 40 1 20 3 40 0 µg or al 19 8 10 IU ox yt oc in i.m . E l- R ef ae y H , N oo h R , O ’B ri en P ,e ta l. D ep t. of O bs te tr ic s an d G yn ae co lo gy ,U ni ve rs it y C ol le ge H os pi ta l, L on do n, U K T he m is op ro st ol th ir d st ag e of la bo r st ud y: a ra nd om iz ed co nt ro lle d co m pa ri so n be tw ee n or al ly ad m in is te re d m is op ro st ol an d st an da rd m an ag em en t B JO G 20 00 ; 10 7: 11 04 –1 0 8 10 00 50 1 50 0 µg or al 49 9 st an da rd ox yt oc ic re gi m en s (1 0 IU ox yt oc in or 0. 5 m g er go m et ri ne or 1 m ls yn to m et ri ne ) C oo k C M , S pu rr et t B , M ur ra y H D ep t. of O bs te tr ic s an d G yn ae co lo gy ,U ni ve rs it y of S yd ne y at N ep ea n H os pi ta lP en ri th ,N ew S ou th W al es ,A us tr al ia A ra nd om iz ed cl in ic al tr ia l co m pa ri ng or al m is op ro st ol w it h sy nt he ti c ox yt oc in or sy nt om et ri ne in th e th ir d st ag e of la bo r A us tN Z J O bs te t G yn ae co l 19 99 ;3 9: 41 4– 19 8 86 3 42 4 40 0 µg or al 43 9 st an da rd ox yt oc ic re gi m en s (1 0 IU ox yt oc in i.m .o r 1 m ls yn to m et ri ne i.m .) T ab le 1 C on tin ue d 188 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:37 Color profile: Generic CMYK printer profile Composite Default screen 167 Overview of misoprostol studies in postpartum hemorrhage A m an t F ,S pi tz B ,T im m er m an D , et al . D ep t. of O bs te tr ic s an d G yn ae co lo gy ,U ni ve rs it y H os pi ta ls L eu ve n, B el gi um M is op ro st ol co m pa re d w it h m et hy le rg om et ri ne fo r th e pr ev en ti on of P P H :a do ub le -b lin d ra nd om iz ed tr ia l B r J O bs te t G yn ae co l 19 99 ;1 06 : 10 66 –7 0 8 20 0 10 0 60 0 µg or al 10 0 0. 2 m g m et hy le rg om et ri ne i.v . S ur be k D V , F eh r P M , H os li I, et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, U ni ve rs it y of B as el ,S w it ze rl an d O ra lm is op ro st ol fo r th e th ir d st ag e of la bo r: a ra nd om iz ed pl ac eb o- co nt ro lle d tr ia l O bs te tG yn ec ol 19 99 ;9 4: 25 5– 8 8 65 31 60 0 µg or al 34 pl ac eb o B am ig bo ye A A , H of m ey r G J, M er re ll D A D ep t. of O bs te tr ic s an d G yn ec ol og y, C or on at io n H os pi ta l, an d U ni ve rs it y of th e W it w at er sr an d, Jo ha nn es bu rg ,S ou th A fr ic a R ec ta lm is op ro st ol in th e pr ev en ti on of P P H :a pl ac eb o- co nt ro lle d tr ia l A m J O bs te t G yn ec ol 19 98 ; 17 9: 10 43 –6 8 54 6 27 1 40 0 µg re ct al 27 5 pl ac eb o H of m ey r G J, N ik od em V C , de Ja ge r M , et al . D ep t. of O bs te tr ic s an d G yn ae co lo gy ,C or on at io n H os pi ta la nd U ni ve rs it y of th e W it w at er sr an d, Jo ha nn es bu rg ,S ou th A fr ic a A ra nd om iz ed pl ac eb o co nt ro lle d tr ia lo f or al m is op ro st ol in th e th ir d st ag e of la bo r B r J O bs te t G yn ae co l 19 98 ;1 05 : 97 1– 5 8 50 0 25 0 40 0 µg or al 25 0 pl ac eb o B am ig bo ye A A , M er re ll D A , H of m ey r G J, et al . D ep t. of O bs te tr ic s an d G yn ec ol og y, N at al sp ru it H os pi ta la nd th e U ni ve rs it y of th e W it w at er sr an d, Jo ha nn es bu rg ,S ou th A fr ic a R an do m iz ed co m pa ri so n of re ct al m is op ro st ol w it h sy nt om et ri ne fo r m an ag em en t of th ir d st ag e of la bo r A ct a O bs te t G yn ec ol S ca nd 19 98 ;7 7: 17 8– 81 8 49 1 24 1 40 0 µg re ct al 25 0 1 m ls yn to m et ri ne i.m .( 5 IU sy nt oc in on e an d 0. 5 m g er go m et ri ne m al ea te 0. 5 m g) E l- R ef ae y H , O ’B ri en P , M or af a W ,e ta l. D ep t. of O bs te tr ic s an d G yn ae co lo gy ,U ni ve rs it y C ol le ge H os pi ta l, L on do n, U K U se of or al m is op ro st ol in th e pr ev en ti on of P P H B JO G 19 97 ; 10 4: 33 6– 9 8 23 7 23 7 60 0 µg or al 0 – P P H ,p os tp ar tu m he m or rh ag e 189 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:37 Color profile: Generic CMYK printer profile Composite Default screen 168 POSTPARTUM HEMORRHAGE A ut ho rs In st itu tio ns S tu dy tit le Jo ur na l n P ar tic ip an ts in m is op ro st ol gr ou p D os ag e of m is op ro st ol R ou te of ad m in is tr at io n P ar tic ip an ts in co nt ro l gr ou p( s) C on tr ol ag en t( s) P ra ta N , M ba ru ku G , C am pb el lM , et al . B ix by P op ul at io n P ro gr am , S ch oo lo f P ub lic H ea lt h, U ni ve rs it y of C al if or ni a, B er ke le y, U S A C on tr ol lin g P P H af te r ho m e bi rt hs in T an za ni a In tJ G yn ae co l O bs te t2 00 5; 90 :5 1– 5 84 9 45 4 10 00 µg re ct al 39 5 cu rr en t pr ac ti ce s W al ra ve n G , D am ph a Y , B it ta ve B ,e ta l. R ep ro du ct iv e H ea lt h P ro gr am m e, M ed ic al R es ea rc h C ou nc il L ab or at or ie s, F ar af en ni , T he G am bi a, S ou th A fr ic a M is op ro st ol in th e tr ea tm en t of P P H in ad di ti on to ro ut in e m an ag em en t: a pl ac eb o ra nd om iz ed co nt ro lle d tr ia l B JO G 20 04 ; 11 1: 10 14 –1 7 16 0 79 60 0 µg 20 0 µg or al an d 40 0 µg su bl in gu al 81 pl ac eb o H of m ey r G J, F er re ir a S , N ik od em V C , et al . E ff ec ti ve C ar e R es ea rc h U ni t, U ni ve rs it y of W it w at er sr an d an d F or t H ar e, an d E as t L on do n H os pi ta lC om pl ex ,E as t L on do n, S ou th A fr ic a M is op ro st ol fo r tr ea ti ng P P H : a ra nd om iz ed co nt ro lle d tr ia l [I S R C T N 72 26 33 57 ] B M C P re gn an cy C hi ld bi rt h 20 04 ;4 :1 6 23 8 11 7 10 00 µg 20 0 µg or al an d 40 0 µg su bl in gu al an d 40 0 µg re ct al 12 1 pl ac eb o S ho ja iR , D es br ie re R , D hi fa lla h S ,e ta l. S er vi ce de gy ne co lo gi e- ob st et ri qu e, C H U N or d, M ar se ill e, F ra nc e [R ec ta lm is op ro st ol fo r P P H ] G yn ec ol O bs te t F er til 20 04 ; 32 :7 03 –7 41 41 10 00 µg re ct al 0 – L ok ug am ag e A U ,S ul liv an K R ,N ic ul es cu I, et al . D ep t. of O bs te tr ic s & G yn ae co lo gy ,R oy al F re e an d U ni ve rs it y C ol le ge L on do n S ch oo l, L on do n, U K A ra nd om iz ed st ud y co m pa ri ng re ct al ly ad m in is te re d m is op ro st ol ve rs us S yn to m et ri ne co m bi ne d w it h an ox yt oc in in fu si on fo r th e ce ss at io n of pr im ar y P P H A ct a O bs te t G yn ec ol S ca nd 20 01 ;8 0: 83 5– 9 64 32 80 0 µg re ct al 32 1 m ls yn to m et ri ne i.m .( 5 IU sy nt oc in on e an d 0. 5 m g er go m et ri ne m al ea te ) pl us 10 IU ox yt oc in i.v . A bd el -A le em H , E l- N as ha r I, A bd el -A le em A D ep t. of O bs te tr ic s & G yn ec ol og y, F ac ul ty of M ed ic in e, A ss iu t U ni ve rs it y, A ss iu t, E gy pt M an ag em en t of se ve re P P H w it h m is op ro st ol In tJ G yn ae co l O bs te t2 00 1; 72 :7 5– 6 18 18 60 0 µg or 10 00 µg re ct al 0 – O ’B ri en P , E l- R ef ae y H , G or do n A ,e ta l. D ep t. of O bs te tr ic s an d G yn ae co lo gy ,U ni ve rs it y C ol le ge H os pi ta l, L on do n, U K R ec ta lly ad m in is te re d m is op ro st ol fo r th e tr ea tm en t of P P H un re sp on si ve to ox yt oc in an d er go m et ri ne :a de sc ri pt iv e st ud y O bs te tG yn ec ol 19 98 ;9 2: 21 2– 14 14 14 10 00 µg re ct al 0 – P P H ,p os tp ar tu m he m or rh ag e T ab le 2 M is op ro st ol fo r tr ea tm en t 190 Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp 30 August 2006 14:20:37 Color profile: Generic CMYK printer profile Composite Default screen << /ASCII85EncodePages false /AllowTransparency false /AutoPositionEPSFiles true /AutoRotatePages /None /Binding /Left /CalGrayProfile (Dot Gain 20%) /CalRGBProfile (sRGB IEC61966-2.1) /CalCMYKProfile (U.S. Web Coated \050SWOP\051 v2) /sRGBProfile (sRGB IEC61966-2.1) /CannotEmbedFontPolicy /Error /CompatibilityLevel 1.3 /CompressObjects /Tags /CompressPages true 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