International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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A literature review was conducted to determine whether misoprostol is an effective treatment for postpartum hemorrhage (PPH) and in what dose. All English language articles published before March 2007 reporting on misoprostol for treatment of PPH were reviewed. ⋯ Nonetheless, PPH remains a major killer of women worldwide, and new treatment options are widely sought. For this reason, we recommend a single dose of misoprostol 600 microg oral or sublingual for PPH treatment in instances when other treatments have either failed to work or are not available.
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As a stable, orally active and cheap uterotonic, misoprostol would appear ideally suited to the prevention of postpartum hemorrhage (PPH) in the developing world. Following numerous clinical trials, it appears that misoprostol prophylaxis using an oral or sublingual dose of 600 microg is more effective than placebo at preventing PPH in community births (relative risk 0.59, 95% confidence intervals 0.41-0.84), but not in hospital settings (RR 1.23, 95% CI 0.86-1.74). ⋯ In the event of continued hemorrhage, a minimum of 2 h should lapse after the original dose before a second dose is given. If the initial dose was associated with pyrexia or marked shivering, at least 6 h should lapse before the second dose is given.
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Int J Gynaecol Obstet · Apr 2006
Review Practice GuidelineSOGC clinical practice guidelines. Ultrasound evaluation of first trimester pregnancy complications. Number 161, June 2005.
First, to review normal embryonic development and the sonographic evidence of early pregnancy failure; second, to review sonographic evidence of ectopic pregnancy. ⋯ There is good (class A) evidence that current ultrasound technology can distinguish between normal and abnormal pregnancies in the first trimester. There is good (class A) evidence that transvaginal ultrasound in conjunction with quantitative-HCG can diagnose ectopic pregnancy.
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Int J Gynaecol Obstet · Mar 2006
Review Comparative StudyPostpartum hemorrhage in resource-poor settings.
Despite the strong interest of international health agencies, worldwide maternal mortality has not declined substantially over the past 10 years. Postpartum hemorrhage (PPH) is the most common cause of maternal death across the world, responsible for more than 25% of deaths annually. Although effective tools for prevention and treatment of PPH are available, most are not feasible or practical for use in the developing world where many births still occur at home with untrained birth attendants. ⋯ In light of these barriers, low-technological replacements for treatments commonly applied in the developed-world must be utilized. Community education, improvements to emergency care systems, training for birth attendants, misoprostol, and Uniject have shown promise as potential solutions. In the short term, it is expedient to capitalize on practical opportunities that utilize the existing strengths and resources in each community or region in order to implement appropriate solutions to save the lives of women during childbirth.