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Running Head: LITERATURE REVIEW

Literature Review

Ashlee S. Ceraulo

Grand Canyon University NSG 324

April 26, 2020

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LITERATURE REVIEW
Literature Review: Postpartum Hemorrhage and Effective Treatments

The clinical issue bring addressed is whether administration of misoprostol or oxytocin in

the third stage of labor would more efficiently prevent postpartum hemorrhage within the first 24

hours of birth in women who have just delivered a neonate vaginally. There are multiple studies

done to show the comparative nature of the two drugs, measuring each ability to control the

duration of labor, amount of bleeding and clots, and the amount of side effects as a result

(Sabitha, Sirisha, & Mohan, 2017). Misoprostol has been shown to have stronger uterotonic

effects therefore reducing the time of labor and decreasing chances of hemorrhage in the third

stage of labor. Whereas, in the women who are given oxytocin still are able to experience

successful births but are more likely to have a longer labor and more side effects such as

shivering and pyrexia (Sabitha, Sirisha, & Mohan, 2017). Misoprostol is also considered to be

more affordable as well as easier to administer sublingually as compared to oxytocin. One of the

most common causes of postpartum hemorrhage is uterine atony in the unsuccessful timing or

drug chosen and its ability and strength to adequately contract the uterus, and throughout the

comparative studies misoprostol is the drug of choice to more effectively control the third stage

of labor. The exact methods of the averaged studies were to administer each drug into separated

groups of women, (group A and group B), in a randomized method to receive one dose of either

600 mcg rectal misoprostol or 10 units of intramuscular oxytocin (Narrey, Mahajan, Vij, Sharma,

& Chaudhary, 2015). The blood loss, duration of third stage labor, incidence of side effects, and

complications were then documented after the drugs were administered throughout labor

(Narrey, Mahajan, Vij, Sharma, & Chaudhary, 2015). This paper will effectively elaborate the

theory, “In women who have just delivered a neonate vaginally, would administration of

misoprostol or oxytocin in the third stage of labor more efficiently prevent postpartum
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LITERATURE REVIEW
hemorrhage within the first 24 hours after birth?”, through a series of research articles exhausting

and documenting both given treatments.

Methods

The methods and criteria for these articles to be effective in this research paper are rather

extensive. Each article needed to within the five-year requirements, to ensure the relevancy and

freshness of the material. The articles also needed to be peer reviewed, to help with the assurance

of truthfulness and accuracy of the research. Also, I had to ensure that all articles had the two

drugs of choice, oxytocin and misoprostol in the quantitative studies, and the assumption of

better pharmacology in the qualitative. Lastly, I needed to ensure all articles were looking for the

same complications and guidelines with the use of the drugs, such as; monitoring postpartum

hemorrhaging, side effects, and duration of the third stage of labor all within 24 hours.

Synthesis of Literature

In this first article to be discussed, A Comparative Study of

Oxytocin/Misoprostol/Methylergometrine For Active Management of The Third Stage of Labor,

they conduct a study where two groups of 100 women are to receive sublingual misoprostol and

intramuscular oxytocin in the third stage of labor and the blood loss, side effects, and

complications were monitored (Sabitha, Sirisha, & Mohan, 2017). They ultimately were able to

find that misoprostol produced the least amount of blood loss (113mL), with the shortest

duration, yet shared side effects with the other drugs of increased blood pressure, shivering, and

pyrexia (Sabitha, Sirisha, & Mohan, 2017). Both drugs were however proved “effective” in the

initiation of labor, yet misoprostol is more efficient and cost effective, with less incidence of

complication.
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The next article, Rectal Misoprostol Versus Intramuscular Oxytocin for Prevention of

Post-Partum Hemorrhage, randomized women into a group A and a group B, where group A

was to receive rectal misoprostol and group B intramuscular oxytocin. The study was closely

monitoring the amount of blood loss, duration of the third stage of labor, side effects, pre and

post-delivery hemoglobin, and additional use of uterotonics (Narrey, Mahajan, Vij, Sharma, &

Chaudhary, 2015). The study showed that misoprostol was able to contract the uterus within only

a few minutes, therefore most effectively controlling postpartum hemorrhage. However,

oxytocin was also found effective in inducing labor efficiently yet produced fevers more often,

with still trailing consistently with the results if misoprostol regarding pre and post hemoglobin

and duration.

The third article, being the only qualitative one, Labor Pain Experiences and

Perceptions: A Qualitative Study Among Post-Partum Women in Ghana, is able to delineate a

different perspective on the different labor option, coming directly from the mothers themselves.

This article demonstrated women whom have experienced a vaginal birth with different methods

of pain control. These women relate to my PICOT question through begging for a, “reduction of

severe pain”, and are simply lacking the properly educated healthcare professionals to bring in

the most statistically effective uterotonic medications, such as misoprostol and oxytocin, in order

to control this (Aziato, 2017). There were 14 post-partum women included in an optional study

of questions that led the scientists to these results, being that there are better pharmological

methods needed, given the purpose and validity of my research choice.

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LITERATURE REVIEW
Areas of Further Study

When discussing the current articles, it is made clear that misoprostol is able to use a

stronger force to contract the uterus, therefore decreasing the amount of blood loss and chances

of postpartum hemorrhage (Sabitha, Sirisha, & Mohan, 2017). Misoprostol is also confirmed to

be the most affordable option compared to oxytocin. The unknown is currently whether or not

there are certain groups of people with abnormal medical circumstances that would react

differently to each drug, for example, it is unknown if patients with something like an HPV

infection in the cervix, would be safer with a drug such as oxytocin, rather than the stronger

uterotonic, misoprostol. This unknown can carry to virtually any medical disorder even

nonrelated to the reproductive system. As far as what needs to be studied further, is the exact

cause of the side effects caused by both oxytocin and misoprostol, and why these are happening

in each and if there are any co-relations to them unrelated to the drug itself.

Conclusion

In conclusion, it was able to be found in all three articles that have been discussed that in

women who have just delivered a neonate vaginally, administration of misoprostol or oxytocin in

the third stage of labor both efficiently prevent postpartum hemorrhage within the first 24 hours

after birth, however decreased incidences of complication and increased uterine strength award

to misoprostol. The studies showed that misoprostol is superior in three ways, “reduction of

cesarean rate, induction to delivery time is shorter, and induction to active phase duration is also

shorter in misoprostol induced labor.” (Sabitha, Sirisha, & Mohan, 2017). This information in

total supports the PICOT stance through adequately testing both drugs in the same population of

woman delivering vaginally in the same stage of labor, all within the first 24 hours carefully
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monitored for hemorrhaging or complications. The PICOT can officially be declared as

answered, with misoprostol being the superior drug of choice for the induction of vaginal labor.
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References

Aziato, L., Acheampong, A. K., & Umoar, K. L. (2017). Labour pain experiences and

perceptions: a qualitative study among post-partum women in Ghana. BMC

Pregnancy and Childbirth, 17(1), 22-69. doi: 10.1186/s12884-017-1248-1

Narrey, N., Mahajan, N., Vij, A., Sharma, R., & Chaudhary, U. K. (2015). Rectal Misoprostol

Versus Intramuscular Oxytocin For Prevention Of Post - Partum Haemorrhage. Journal

of Evolution of Medical and Dental Sciences, 4(55), 9606–9612. doi:

10.14260/jemds/2015/1387

Sabitha, M., Sirisha, K., & Mohan, M. S. (2017). A Comparative Study of Oxytocin &

Misoprostol in Active Management of Third Stage of Labour. Journal of Nepalgunj

Medical College, 4(66), 3969–3972. doi: 10.18410/jebmh/2017/792