***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective To evaluate whether routine administration of sublingual misoprostol 600 μg after delivery reduces postpartum haemorrhage . Design R and omised double blind placebo controlled trial . Setting Primary health centre in Bissau , Guinea-Bissau , West Africa . Participants 661 women undergoing vaginal delivery . Intervention Misoprostol 600 μg or placebo administered sublingually immediately after delivery . Main outcome measures Postpartum haemorrhage , defined as a loss of ≥ 500 ml and decrease in haemoglobin concentration after delivery . Results The incidence of postpartum haemorrhage was not significantly different between the two groups , the relative risk being 0.89 ( 95 % confidence interval 0.76 to 1.04 ) in the misoprostol group compared with the placebo  group . Mean blood loss was 10.5 % ( −0.5 % to 20.4 % ) lower in the misoprostol group than in the control group . Severe postpartum haemorrhage of ≥ 1000 ml or ≥1500 ml occurred in 17 % ( 56 ) and 8 % ( 25 ) in the placebo group and 11 % ( 37 ) and 2 % ( 7 ) in the misoprostol group . Significantly fewer women in the misoprostol group experienced a loss of ≥1000 ml ( 0.66 , 0.45 to 0.98 ) or ≥ 1500 ml ( 0.28 , 0.12 to 0.64 ) . The decrease in haemoglobin concentration tended to be less in the misoprostol group , the mean difference between the two groups being 0.16 mmol/l ( −0.01 mmol/l to 0.32 mmol/l ) . Conclusion Sublingual misoprostol  reduces the frequency of severe postpartum haemorrhage Purpose In India , two third of maternal deaths occur in rural areas where there is lack of transportation facilities , lack of refrigeration to store the injectable uterotonic drug such as oxytocin , lack of skilled personnel to administer them and lack of sterile syringes and needles . Hence , this study was conceived to evaluate misoprostol as a safe , effective , easily administered non-parenteral drug in the prevention of postpartum hemorrhage . Methods This study was conducted during the period from August 2012 to July 2014 . Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study . A total of 500 women were r and omized to two groups , 250 in each group , either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder . Patient factors , labor parameters , blood loss and side effects were noted . Results The women in both the groups were well matched with respect to age , parity , gestational age and labor parameters . There was statistical significance in the blood loss ( p = 0.04 ) between the two groups . The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group . Shivering was the statistically significant side effect ( p = 0.004 ) in the misoprostol group and nausea was the statistically significant side effect ( p = 0.003 ) in the oxytocin group . Conclusions Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage The haemodynamic effects of oxytocin receive scant attention in pharmacology texts , but may be clinical ly significant in vulnerable patients . Despite prescriber information recommending a dose of 5 international units by slow i.v . injection , it is the authors ' experience that it is very common practice in the UK to give 10 units as a rapid injection . We therefore conducted a r and omised , double-blind study of the haemodynamic changes induced by rapid bolus of 5 or 10 units of oxytocin in 34 healthy term parturients at caesarean section under spinal anaesthesia .  There was a small but statistically significant ( P < 0.05 ) reduction in mean arterial pressure from baseline 30 s after a 10-unit bolus . However , large , statistically significant increases in heart rate and cardiac output occurred 1 min after 5 units and 2 min after 10 units . These changes peaked 1 min after oxytocin administration and were greater in the 10-unit group ( P < 0.05 ) . The importance of these findings is that some women with hypovolaemia or cardiac disease may be unable to mount these compensatory responses and are therefore at risk of haemodynamic collapse after oxytocin boluses . This has been illustrated by a maternal death reported to the Confidential Enquiries into Maternal Deaths in the United Kingdom . The need to adhere to a dose regimen of 5 units by slow injection needs re-emphasis , but no evidence exists to cl aim that even this will be haemodynamically inert . We therefore recommend that oxytocin boluses be avoided in women with hypovolaemia or cardiac disease OBJECTIVE To compare the effects of oral misoprostol 800 mug with intramuscular oxytocin 10 IU in routine management of the third stage of labour . METHODS This r and omized controlled trial was performed in a rural district hospital in Ghana , West Africa , and enrolled women in labour with anticipated vaginal delivery and no known medical contraindication to prostagl and in administration . Women were r and omized to receive oral misoprostol 800 mug or intramuscular oxytocin 10 IU . Blood sample s were taken to determine hemoglobin concentration before delivery and at 12 hours post partum . Treatment was administered at delivery of the anterior shoulder . The primary outcome was the change in hemoglobin concentration from before to after delivery . Secondary outcomes included other measures of blood loss and presumed medication side effects . RESULTS In total , 450 women were enrolled in the study . Their baseline characteristics were similar . There was no significant difference between the groups in the change in hemoglobin concentration  ( misoprostol 1.07 g/dL and oxytocin 1.00 g/dL ) . The only significant secondary outcomes were shivering ( 80.7 % with misoprostol vs. 3.6 % with oxytocin ) and pyrexia ( 11.4 % with misoprostol , none with oxytocin ) . CONCLUSION Routine use of oral misoprostol 800 microg appears to be as effective as 10 IU parenteral oxytocin in minimizing blood loss during the third stage of labour , as determined by change in hemoglobin concentration . Misoprostol appears to be a safe , inexpensive , and effective uterotonic for use in rural and remote areas , where intravenous oxytocin may be unavailable Summary In this study , 100 singleton pregnant women underwent a caesarean delivery under general anaesthesia and were studied in terms of postpartum bleeding using oxytocin or misoprostol . Patients were r and omly divided into two equal groups . One group received two tabs of misoprostol 200 μg sublingually and the second group took intravenous infusion of 20 units of oxytocin at the rate of 10 cc/min immediately after delivery until full contraction of the uterine . The amount of blood loss was lower in misoprostol group comparing with oxytocin group ( 608.91 ml vs 673.9 ml ) ( p = 0.048 ) and this difference was statistically significant . The need to give additional oxytocin therapy in oxytocin group ( 36 % ) was significantly higher than misoprostol group ( 14 % ) ( p = 0.032 ) . It seems that the efficacy of sublingual misoprostol is equivalent to that of low dose intravenous oxytocin in reducing postpartum haemorrhage at caesarean section . Misoprostol has some other advantages like long shelf -life , stability at room temperature and oral use International research partnerships bring together some of the best and the brightest in an effort to tackle global health problems . Such collaborations also pose complex challenges , such as maintaining ethical principles in the conduct of research in developing nations . In implementing a r and omized clinical trial to reduce  postpartum hemorrhage ( PPH ) during childbirth in rural India , U.S. and Indian collaborators addressed three such issues : the appropriateness of an ethical r and omized controlled trial in the developing world , the inclusion of a placebo arm , and the relevance of informed consent in a semiliterate rural population Background The two most commonly used uterotonic drugs in caesarean section are oxytocin and carbetocin , a synthetic oxytocin analogue . Carbetocin has a longer half-life when compared to oxytocin , result ing in a reduced use of additional uterotonics . Oxytocin is known to cause fewer cardiovascular side effects when administered as a short-infusion compared to as an intravenous bolus . Based on these findings , we aim at comparing carbetocin 100 mcg given as a slow intravenous bolus with carbetocin 100 mcg applied as a short-infusion in 100 ml 0.9 % sodium chloride in women undergoing a planned or unplanned caesarean delivery . We hypothesise uterine contraction not to be inferior to a bolus application ( primary efficacy endpoint ) and greater haemodynamic stability to be achieved after a short-infusion than after a bolus administration , as measured by heart rate and mean arterial blood pressure ( primary safety endpoint ) . Methods / Design This is a prospect i ve , double-blind , r and omised controlled , investigator-initiated , non-inferiority trial taking place at the University Hospital Basel , Switzerl and .Uterine  tone is quantified by manual palpation by the obstetrician using a linear analogue scale from 0 to 100 at 2 , 3 , 5 and 10 minutes after cord clamping . We will evaluate whether the lower limit of the confidence interval for the difference of the maximal uterine tone within the first 5 minutes after cord clamping between both groups does not include the pre-specified non-inferiority limit of −10 . Both haemodynamic secondary endpoints will be analysed using a linear regression model , adjusting for the baseline value and the dosage of vasoactive drug given between cord clamping and 1 minute thereafter , in order to investigate superiority of a short-infusion as compared to a bolus application . We will follow the extension of CONSORT guidelines for reporting the results of non-inferiority trials . Discussion Haemodynamic stability and adequate uterine tone are important outcomes in caesarean sections . The results of this trial may be used to optimise these factors and thereby increase patient safety due to a reduction in cardiovascular side effects . Trial registration Clinical trials.gov NCT02221531 on 19 August 2014 and www.kofam.ch SNCTP000001197 on 15 November 2014 OBJECTIVE To assess the effectiveness of 800 microg of rectal misoprostol compared with an intravenous infusion of 5 IU of oxytocin as prophylaxis against postpartum hemorrhage ( PPH ) . METHODS A total of 514 women in labor were r and omized into two groups ( 257 women in each ) . Within 1 minute of delivery of the anterior shoulder participants in group 1 received 800 microg of rectal misoprostol and 1 ampoule of normal saline in 5 mL lactated Ringer solution intravenously ; group 2 received a rectal placebo tablet and 5 IU of oxytocin in 5 mL lactated Ringer solution intravenously . RESULTS Both groups were comparable regarding the need for uterotonics , blood transfusion , and hematocrit drop of 10 % or greater , 24 hours post partum ( P=0.54 , P=0.25 , and P=0.85 , respectively ) . Fever was significantly higher among misoprostol patients ( 18.7 % vs 0.8 % , P<0.001 ) . CONCLUSIONS Routine use of 800 microg of rectal misoprostol was effective in reducing blood loss after delivery . We recommend the regimen for low-re source , busy obstetric setting Objective To evaluate the side effects of 600 μg misoprostol orally during the first 24 hours after administration in the third stage of labour Purpose In order to prevent postpartum hemorrhage in caesarean section under spinal anesthesia , patients routinely receive oxytocin . In this study we compared the efficacy of Methylergonovine and Oxytocin on hemodynamic stability and bleeding amount in caesarean section . Material s and methods In this r and omised controlled trial study , 80 patients c and i date for elective caesarean section under spinal anesthesia divided to two groups : 40 patients in control group received oxytocin and 40 ones in case group received methylergonovine . Results There was no differences between groups in Mean age , baseline hemodynamic values , after spinal anesthesia and recovery ( except diastolic blood pressure min 20 ) , time of uterine atony , dizziness ; nausea and vomiting . After drug administration ( oxytocin and methylergonovine ) , systolic blood pressure in minutes 1 , 10 , 15 and diastolic blood pressure in minutes 1 , 3 , 20 increased in case group statistically more than control group . In control group , heart rate in minutes 1 , 5 increased significantly more than the other group . Mean arterial blood pressure in minutes 1 , 3 , 5 , 10 , 15 reduced significantly more than in control group . Need 
    Output:
    
Low‐certainty evidence suggests that misoprostol , injectable prostagl and ins , and ergometrine may make little or no difference to this outcome compared with oxytocin .
All agents except ergometrine and injectable prostagl and ins were effective for preventing PPH ≥ 1000 mL when compared with placebo or no treatment .
The two combination regimens were associated with important side effects .
Ergometrine plus oxytocin increases the likelihood of vomiting ( RR 2.93 , 95 % CI 2.08 to 4.13 , moderate certainty ) and may make little or no difference to the risk of hypertension , however absolute effects varied considerably and the certainty of the evidence was low for this outcome .
Authors ' conclusions All agents were generally effective for preventing PPH when compared with placebo or no treatment .
Ergometrine plus oxytocin combination , carbetocin , and misoprostol plus oxytocin combination may have some additional desirable effects compared with the current st and ard oxytocin .
The two combination regimens , however , are associated with significant side effects  .
Carbetocin may be more effective than oxytocin for some outcomes without an increase in side effects