Use of misoprostol in the treatment of postpartum hemorrhage: a pharmacoepidemiological approach

Einstein (Sao Paulo). 2019 Nov 7:18:eAO5029. doi: 10.31744/einstein_journal/2020AO5029. eCollection 2020.
[Article in English, Portuguese]

Abstract

Objective: To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women.

Methods: A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized.

Results: A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death.

Conclusion: Misoprostol showed to be effective and safe for treating postpartum hemorrhage.

Objetivo: Caracterizar o uso do medicamento misoprostol para o tratamento da hemorragia pós-parto em gestantes.

Métodos: Estudo observacional descritivo realizado por meio de dados secundários de gestantes que fizeram uso do misoprostol para tratamento da hemorragia pós-parto em maternidade pública de referência, no período de julho de 2015 a junho de 2017. Caracterizaram-se os perfis clínico e sociodemográfico das gestantes, o padrão de utilização do misoprostol e sua taxa de sucesso no controle da hemorragia pós-parto.

Resultados: Foram identificadas 717 prescrições do misoprostol. Destas, 10% foram para tratamento da hemorragia pós-parto. Predominaram gestantes adultas jovens, casadas, com Ensino Médio completo, raça branca, da região urbana, multíparas (68,1%) e 25% apresentavam cesáreas prévias. A idade gestacional média foi 39 semanas e 51,4% das gestantes tiveram parto cesárea. Houve uso profilático de ocitocina em 47,2% das mulheres. O tratamento da hemorragia pós-parto eve sucesso em 84,7% das gestantes que usaram misoprostol. Destas, 79,2% também usaram ocitocina e 54,2% metilergometrina. Apenas 13,5% das gestantes tiveram menos de cinco consultas de pré-natal, e a principal causa da hemorragia pós-parto foi atonia uterina. Foram registrados 13 casos de complicações após a hemorragia, 15,3% necessitaram de hemotransfusão e houve um caso de óbito materno.

Conclusão: O misoprostol demonstrou ser efetivo e seguro para o tratamento da hemorragia pós-parto.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Gestational Age
  • Humans
  • Methylergonovine / therapeutic use
  • Misoprostol / therapeutic use*
  • Oxytocics / therapeutic use*
  • Oxytocin / therapeutic use
  • Postpartum Hemorrhage / drug therapy*
  • Pregnancy
  • Young Adult

Substances

  • Oxytocics
  • Misoprostol
  • Oxytocin
  • Methylergonovine