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Register a new userThe Place of Misoprostol in Management of Post Partum Hemorrhage (P.P.H) due to Uterine Atony
أثر الميزوبروستول Misoprostol و فعاليته في نزوف عواقب الولادة الناجمة عن العطالة الرحمية
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Added by
Damascus University ورقة بحثية
Publication date
2006
fields
Medicine
and research's language is
العربية
Authors
تمام الأشقر( باحث )
Created by
Shamra Editor
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إيضاح دور تطبيق الميزوبروستول Misoprostol و أهميته في حـالات العطالـة الرحميـة المعندة على المقبضات الرحمية التقليدية، و مدى استجابة مثل هذه النزوف لهذا الإعطاء. مكان الدراسة: مشفى التوليد و أمراض النساء الجامعي بدمشق. مدة الدراسة: الفترة الواقعة بين 2 كانون الثاني 2004 و 2 كانون الثاني 2005 . حجم العينة: 18 مريضة خلال فترة الدراسة. طريقة انتقاء العينة: مريضات نزوف عواقب الولادة الناجمة عن العطالـة الرحميـة غيـر المستجيبة لإعطاء مقبضات الرحم التقليدية من ميترجين و أوكسيتوسين. يعد استخدام الميزوبروستول Misoprostol شرجياً بجرعة 1000 ميكروغرام ( 5 حبـات ) علاجاً فعالاً في معالجة نزف العطالة المعند على المعالجة بالأوكسيتوسين و الميترجين. تؤكد هذه الدراسة المحلية ما ورد في الدراسات العالمية عن أهمية استخدام الميزوبروستول Misoprostol و فعاليته ضرورة تأمينه في مشافينا و استخدامه في معالجة حـالات العطالـة الرحمية.
This study was organized to find out the role and the efficacy of Misoprostol in treating postpartum hemorrhage unresponsive to traditional agents that contract the uterus . Place : Maternity hospital at Faculty of Medicine in Damascus university Time : from 2, January, 2004 to 2, January, 2005 . Number of patients : 18 patients who met the criteria in that period of time . Criteria of selection : any patient with post partum hemorrhage due to uterine atony that did not respond well to the administration of Oxytocin and Metergin . Misoprostol is an effective treatment of post partum hemorrhage due to uterine atony unresponsive to Oxytocin and Metergin. Our study confirms the results of international studies of effectiveness of the use of misoprostol in treating post partum hemorrhage due to uterine atony.
Artificial intelligence review:
Research summary
تتناول هذه الدراسة التي أجراها الدكتور تمام الأشقر دور وفعالية عقار الميزوبروستول في علاج النزيف ما بعد الولادة الناتج عن وهن الرحم والذي لا يستجيب للعلاجات التقليدية مثل الأوكسيتوسين والميترجين. أجريت الدراسة في مستشفى التوليد بكلية الطب في جامعة دمشق خلال الفترة من 2 يناير 2004 إلى 2 يناير 2005، وشملت 18 مريضة استوفت معايير الاختيار. أظهرت النتائج أن الميزوبروستول كان فعالًا في علاج النزيف ما بعد الولادة الناتج عن وهن الرحم والذي لم يستجب للأوكسيتوسين والميترجين، مما يؤكد نتائج الدراسات الدولية حول فعالية هذا العقار في مثل هذه الحالات.
Critical review
دراسة نقدية: تعتبر هذه الدراسة خطوة مهمة في مجال علاج النزيف ما بعد الولادة، إلا أن هناك بعض النقاط التي يمكن تحسينها. أولاً، حجم العينة صغير نسبيًا (18 مريضة فقط)، مما قد يؤثر على تعميم النتائج. ثانياً، لم يتم ذكر تفاصيل كافية حول الجرعات المستخدمة من الميزوبروستول وكيفية إعطائها، وهو أمر مهم لفهم كيفية تطبيق النتائج في الممارسة السريرية. أخيرًا، كان من المفيد تضمين مجموعة مقارنة أخرى تستخدم علاجًا مختلفًا لتقديم صورة أكثر شمولية حول فعالية الميزوبروستول مقارنة بالعلاجات الأخرى.
Questions related to the research
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ما هو الهدف الرئيسي من هذه الدراسة؟
الهدف الرئيسي هو تحديد دور وفعالية الميزوبروستول في علاج النزيف ما بعد الولادة الناتج عن وهن الرحم والذي لا يستجيب للعلاجات التقليدية.
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أين ومتى أجريت هذه الدراسة؟
أجريت الدراسة في مستشفى التوليد بكلية الطب في جامعة دمشق خلال الفترة من 2 يناير 2004 إلى 2 يناير 2005.
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ما هي المعايير التي تم على أساسها اختيار المرضى المشاركين في الدراسة؟
تم اختيار المرضى الذين يعانون من نزيف ما بعد الولادة الناتج عن وهن الرحم والذي لم يستجب لعلاجات الأوكسيتوسين والميترجين.
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ما هي النتائج الرئيسية التي توصلت إليها الدراسة؟
النتائج الرئيسية أظهرت أن الميزوبروستول كان فعالًا في علاج النزيف ما بعد الولادة الناتج عن وهن الرحم والذي لم يستجب للأوكسيتوسين والميترجين.
References used
Andolina, K, Daly, S, Roberts, N, et al , objective measurement of blood loss at delivery. Amj Obstet Gynecol 119,180,69
Veland , K, Maternal Cardiovesical dynamics VII intrapartum Blood Volume changes , Amj Obstet Gynecol 1976, 126, 671
Lokuganage, AV, Sullinan , KR , Niculescu , I , et al , a randomized study comparing redally administration of Misoprostol versus systometrine combined with an oxytocin infusion for the cession of primary postpartum hemorrhage , obstet Gynecol 2001, 80, 835
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This search included 150 pregnant women who had gestational age of 36 weeks or more, and had been admitted to the Department of Obstetrics and Gynecology at Al – Assad University Hospital in Lattakia for the spontaneous vaginal delivery during the st
udy period
( 1\1\2012 to 1\7\ 2013). Exclusion criteria were patients undergoing cesarean section, patients with placenta previa, or abruptio placenta, patients with hemoglobin<9 gm%, pregnancy-induced hypertension or pre eclampsia–eclampsia, grand multiparty, coagulation abnormalities, positive history of PPH, expensive hemorrhage or other medical disorders.
Patients were randomly divided into three groups: ( 1: uterine massage group, 2: 10 units oxytocin in 500 cc glucose 5% intravenously with delivery of the anterior sholder\ control group, 3: three 200µg rectal misoprostol tablets\study group).
No significant differences were observed between the groups regarding baseline characteristics. There was blood loss of ≥500 ml occurred in 18% in the first group, 6% in the second group, 8% in the third group. Routine use of 600 µg of rectal misoprostol was effective in reducing blood loss after delivery ل gm%, pregnancyts with hemoglobin}ergoing cesarean section, patients with placenta pre and g (RR 0.44 ; CI 0.32 – 1.53), but not as effective as intravenous oxytocin (RR 1.33 ; CI 0.4 – 3.39).
Although these were differences, they were not significant (No significant differences were observed between the control and study groups for the length of the third stage of labor, the estimated blood loss, the changes in Hb and Hct concentrations, need for additional uterotonics, manual removal of placenta, blood transfusion…..).
This dose of misoprostol and route of administration were well tolerated, and usual side effects such as shivering and fever were transient, resolved on their own, and were not threatening. Because PPH is the most significant direct cause of maternal mortality and because most of these maternal mortality occurs in low resource countries, misoprostol offers several advantages over oxytocin in such settings. It is formulated as a tablet, widely available and affordable, and it does not need require special storage conditions (i.e. it is stable at ambient room temperature and does not require specific conditions for transfer and has a shelf-life of several years). It also does not require any special skills, equipment, or facilities for its use. So misoprostol can fill a service delivery gap in settings where women and providers are unable to access oxytocin.ل gm%, pregnancyts with hemoglobin}ergoing cesarean section, patients with placenta pre and g
Postpartum Hemorrhage (PPH) is the leading cause of maternal death worldwide. In the developing countries, it is responsible for the death of about 125 000 women each year. In most cases 67-80% are caused by uterine atony.
Uterine massage would re
present a simple intervention with the potential to have a major effect on PPH and maternal mortality in under resourced settings.
Aim: The aim of the present study is to study the effect of uterine massage on the immediate postpartum hemorrhage among primiparae.
Materials and Methods: The study was conducted of al-Assad Hospital and Children & Obstetrics Hospital (Lattakia), a convent sample of 40 primiparae women. Checklist application form was used to assess the postpartum hemorrhage by hemoglobin and hematocrit measurement before applying uterine massage and after the end of procedure.
Results: This study demonstrated that the rate of hemorrhage decreased in the experimental group, hemoglobin and hematocrit was higher (10.4 mg/dl, 32.3%) (P=0.029*) (P=0.015*) among primipara who received uterine massage.
Conclusions and Recommendations: Our present study results advice to apply uterine massage for all women after labor and delivery because its effective in reducing blood loss. It is also recommended to learn nurses how to apply uterine massage.
The study aimed to identify the extent of auditors’ response to
assessed risks of material misstatement due to fraud. To achieve the
study objective a questionnaire was developed that included the most
important audit procedures designed as respon
ses to assessed risks of
material misstatement due to fraud which are classified according to
the International Auditing Standards into two main groups: overall
responses at financial statement level, and other ones at assertion level;
to identify the extent of auditors’ response to those risks within the
research community represented by accredited auditors at Syrian
Commission on Financial Markets and Securities (SCFMS).
The bleeding after delivery (Postpartum Hemorrhage-PPH) is the most important complications that occur after a natural or cesarean delivery, and represents about a quarter of maternal mortality around the world. Midwives play a basis role in preventi
on of bleeding after birth. So This research aims to evaluate the knowledge of midwives about using strategies to prevention and management the bleeding after delivery. Its sample included all midwives in obstetrics departments in Alasad University, Children and Obstetric, and Tishreen University Hospital all in Lattakia city. Data were collected using a questionnaire developed by researcher. The results according to strategies used in prevention and management of bleeding after delivery showed that 60% of the level of knowledge of midwives were "inappropriate". There were significant inverse relationship (P = 0.006) between ages of midwives and level of knowledge. Also showed a significant inverse relationship between number of years of experience with the midwives and level of knowledge (P = 0.01). So we suggest conducting training sessions and educational lectures for midwives with respect to the strategies used in prevention and management of bleeding after delivery, and must evaluate the midwives information about prevention and management of bleeding after delivery periodically and continuously.
Objective: To compare the effectiveness of Misoprostol administered
intravaginally every 12 versus 6 hours for termination of pregnancy in the
first and second trimesters.
Methods: Fifty six pregnant patients at 7 – 22 weeks of gestation were
ran
domized to receive 800 μg (first trimester) and 200 μg either every 12 or
every 6 hours for 48 hours.
Results: The incidence of abortion within 48 hours after initial dose, in the
first trimester was 100% in the two groups, in the second trimester the
incidences were 95.5 and 100%. The incidences of abortion by a single dose
in the first trimester were 85 and 10% in the 12 and 6 hours groups
respectively (P <0.001) The mean abortion intervals 8.3 , 20.2 and 12.4
hours in the 12 and 6 hour group respectively. Side effects were similar in
both groups.
Conclusion: Misoprostol administered vaginally is effective for termination
of first and second trimester pregnancies in non scared uterus. Giving the
medication at a shorter interval from 12 to 6 hours appeared to have no
significant benefit.
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