strict postpartum hemorrhage, the m...

strict postpartum hemorrhage, the most frequent serious complication of delivery, traditionally is managed at blood transfusion or surgery. Oral misoprostol has been advocated as an effective and acceptable therapy. Misoprostol has significant uterotonic properties. Its greatest in number common adverse effects are shivering and pyrexia. In certain circumstances, rectally administered misoprostol can be life-saving. The use of this administration way is increasing worldwide, but the pharmacologic characteristics of rectal misoprostol may not be equivalent to those of oral misoprostol. Khan and El-Refaey studied the pharmacokinetics and side meanings of misoprostol administered rectally during the third stage of labor.

To assess the absorption of misoprostol, they studied 20 women in spontaneous labor of a singleton bound fetus at a teaching hospital in London. The mothers were older than 18 years and had no contraindications to prostaglandin therapy. The patients were randomly assigned to receive 600 mcg of misoprostol orally or rectally as betimes as the umbilical cord was clamped. The cogitation could not be blinded as to treatment allocation. The third stage of labor was managed in the normal manner for the institution with the exception that vital current samples were drawn from an intravenous cannula at baseline and at 75 15 30 45 60 90 120 and 240 minutes after administration of the drug

To assess side tenors 275 mothers were similarly randomized to receive rectal misoprostol in single in kind of two doses (400 mcg [n=91] or 600 mcg [n=92]) or oral misoprostol in a dose of 600 mcg [n=92] The mothers were monitored for pyrexia, vomiting, and shivering. Oral temperature was recorded before delivery and after 20 40 and 60 minutes. Vomiting and shivering were assessed from the birth attendant and the patient forward a self-assessment questionnaire.

The sum of two units groups of patients were well matched in the one and the other studies. The mean maximum plasma concentration of misoprostol was significantly lower (statistically significant) when administered rectally (184 pg through mL compared with 327.9 pg by means of mL), and this maximum concentration took an average 23 minutes longer to achieve when the remedy was given rectally. The profiles of the serum concentrations achieved by the agency of the two routes of administration were quite different. Oral administration terminateed in a rapid peak in an average of 18 minutes, followed at a steep decline in 60 minutes. When administered rectally, the mean maximum concentration was achieved at 405 minutes and declined slowly in united half of the patients. Temperatures rose in all women after delivery, further the average rise was significantly greater (statistically significant) in those treated with oral misoprostol.

heats of more than 38[degrees]C (1004[degrees]F) were recorded in eight of 92 mothers treated orally, and in three of 183 treated rectally. Shivering after delivery was recorded in 76 percent of patients treated orally, 54 percent of those treated with 600 mcg rectally, and 56 percent of those who received 400 mcg rectally. The assign places tos did not differ in vomiting or use of analgesia following delivery.

The authors decide that rectal administration of misoprostol is associated with fewer side imports but results in lower peak on a levels and a different plasma concentration profile than oral administration. As rectal misoprostol becomes more widely used in the management of the third stage of labor, the authors intimate that higher doses administered rectally may be necessary to achieve efficacy without the disadvantages of the oral or vaginal routes

Khan RU El-Refaey H Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol May 2003;101:968-74

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