Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster-randomised non-inferiority community trial.

OBJECTIVE: To assess whether secondary prevention, which preemptively treats women with above-average postpartum bleeding, is non-inferior to universal prophylaxis. DESIGN: A cluster-randomised non-inferiority community trial. SETTING: Health sub-centres and home deliveries in the Bijapur district of Karnataka, India. POPULATION: Women with low-risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub-centre and who consented to be part of the study. METHODS: Auxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour. MAIN OUTCOME MEASURES: Postpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher-level facilities, acceptability and feasibility of the intervention. RESULTS: Misoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference -2.9%, one-sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013). CONCLUSION: Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level. TWEETABLE ABSTRACT: Secondary prevention of postpartum haemorrhage with misoprostol is non-inferior to universal prophylaxis.

A study of morbidity and subsidence of symptoms : subject to time gap of snakebite and treatment.

The objectives of the study were to assess the morbidity and the time taken for the subsidence of symptoms among snakebite victims and study the Interval between snakebite and initiation of treatment It was a hospital based cross-sectional study. Patients were studied at the time of admission and were followed-up until recovery or death. A total of 84 patients were studied between April 2006 and March 2007. The ratio of males to females was 1.5:1.Maximum number of victims were farmers/ labourers. Among the snakebite victims 82.14% were from the nearby rural and semi rural areas and 32.14% of the bites were found to be poisonous. Maximum number of bites (70.23%) occurred in the lower extremities. About 83.31% attended hospital for treatment within the first 5 hours of bite. Most of the patients who received their Initial treatment within first 3-4 hours in hospital were cured faster. Severity of signs and symptoms of envenomation was found to be directly related to the amount of venom injected. Therefore antisnake venom should be given as early as possible, the maximum effect being if given within the first 4 hours.