BRIEF COMMUNICATION Rectal misoprostol vs. 15-methyl prostaglandin F2 a for the prevention of postpartum hemorrhage V. Nellore * , S. Mittal, V. Dadhwal Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India Received 4 November 2005; received in revised form 12 March 2006; accepted 15 March 2006 Postpartum hemorrhage (PPH) is a major cause of morbidity and mortality in both developed and developing countries [1]. Various pharmacologic agents, including oxytocin, ergot preparations, and prostaglandin analogues such as 15-methyl prostaglandin F2 a and prostaglandin E2, have been found to prevent PPH. However, they are expen- sive, associated with adverse effects, and require parenteral administration [1]. Misoprostol is a prostaglandin E1 analogue shown in several randomized controlled trials to be effective in preventing PPH because of its strong uterotonic effects [2—4]. Moreover, misoprostol is inexpensive, stable at room temperature, and easy to administer. The present study compared the efficacy and side effects of 400 Ag of rectal misoprostol with 125 Ag of 15-methyl prostaglandin F2 a in the prevention of PPH. This randomized study was conducted at the Comprehensive Rural Health Services Project, Ballabhgarh, a rural health center under the supervision of the Centre for Community Medi- cine, All India Institute of Medical Sciences Hospital, New Delhi, India. The study included 120 women with spontaneous onset of labor who were in their 37th week of pregnancy or beyond, 60 on the misoprostol group and 60 in the 15- methyl prostaglandin F2 a group. Exclusion criteria were oxytocin induction or augmentation of labor, cesarean delivery, pregnancy duration less than 37 weeks, multiple pregnancy, hemoglobin concen- tration less than 8 g/dL, and known allergy to prostaglandins. Written consent was obtained from all participants. Immediately following de- livery (within 1 min) the women randomly re- ceived either 400 Ag (2 tablets) of misoprostol (Cytotec; Searle Pharmaceuticals, Skokie, IL, USA) rectally, or a 125 Ag intramuscular injection of 15- methyl prostaglandin F2 a (Carboprost; Upjohn Ltd., Crawley, West Sussex, UK). Management of labor was otherwise left to the decision of the attending physician or nurse. Blood loss was estimated, as in other randomized trials on the 0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2006.03.024 4 Corresponding author. Tel.: +91 26593378, +91 265932210; fax: +91 11 26588641. E-mail address: drvimalan@yahoo.co.in (V. Nellore). KEYWORDS Misoprostol; 15-methyl prostaglandin F2 a ; Postpartum hemorrhage International Journal of Gynecology and Obstetrics (2006) 94, 45—46 www.elsevier.com/locate/ijgo