Comparison of efficacy of intramyometrial versus intramuscular prostaglandin F2α (PGF2α) in the management of primary postpartum hemorrhage due to uterine atony.

Objective: To determine the better route of prostaglandin F2α either intramyometrial or intramuscular for the management of uterine atony and to prevent surgical intervention. Study Design: Randomized Controlled Trial. Settings: Bahawal Victoria Hospital. Period: Feb 2018 to July 2018. Material & Method: A total of 266 patients with primary PPH due to uterine atony of 20 to 39 years of age were enrolled in the study. Patients of primary PPH due to bleeding disorders, ruptured uterus, on anticoagulant therapy and hypersensitivity to prostaglandin were excluded. Patients were divided randomly into two groups i.e. Group A (for intramyometrial injection) & Group B (for intramuscular injection). Outcome variables like arrest of bleeding within 30 minutes after start of treatment (efficacy) were noted for successful or unsuccessful outcome. Results: The mean age of women in group A was 26.94 ± 4.43 and in group B was 26.21 ± 4.09 years (p=0.005). The mean parity in group A was 2.92 ± 0.87 and in group B was 2.93 ± 0.98 (p=0.8579). Efficacy was 82.71% in group A (Intramyometrial group) and 91.73% in group B (Intramuscular group) with p-value of 0.0276. Conclusion: This study concluded that intramuscular prostaglandin F2α has better efficacy i.e. 91.73% in a patient of uterine atony for management of primary PPH as compared to intramyometrial rout of administration for prostaglandin F2α.