Efficacy of rectal misoprostol as second-line therapy for the treatment of primary postpartum hemorrhage.

To assess the efficacy of rectal misoprostol as second-line therapy in the management of primary postpartum hemorrhage (PPH) as compared to methylergonovine maleate. This was a retrospective cohort study. Charts from July 2000 to February 2005 were reviewed. Inclusion criteria were patients between 37 and 42 weeks' gestational age who received a clinical diagnosis of PPH following delivery of a singleton pregnancy and who required a second uterotonic following initial oxytocin therapy. The control group represented those receiving methylergonovine maleate (18 patients), and the study group consisted of those receiving misoprostol (40 patients). There was no significant difference in maternal age, gestational age, parity or type of delivery between the 2 groups. There was no significant difference between the 2 groups in the need for blood transfusion (methylergonovine maleate group, 0/18 [0%], misoprostol group, 5/40 [12.5%] [p = 0.11]), the need for third-line medical therapy (methylergonovine maleate group, 10/18 [55.5%], misoprostol group, 22/40 [55%] [p = 0.961) or the need for any surgical intervention (methylergonovine maleate, 4/18 [22.2%], misoprostol 5/40 [12.5%] [p = 0.51]). This limited study suggests that rectal misoprostol is comparable to methergine as second-line therapy for the treatment of 1 primary postpartum hemorrhage.