Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women

Abstract

Objective To compare sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth. Methods In a prospective, randomized, double-blind trial, 530 women without risk of PPH were randomly allocated to receive either 400 μg of misoprostol sublingually or 10 units of oxytocin intramuscularly within 1 minute of delivery. The outcome measures were incidence of PPH, postpartum blood loss, drop in hemoglobin level in 24 hours, need for additional uterotonic drug, incidence of adverse effects, and need for blood transfusion. Student t, χ 2, Mann–Whitney U, and Fisher exact tests were used for comparison. Results Incidence of postpartum hemorrhage (≥ 500 mL) and postpartum blood loss in the misoprostol group were similar to those in the oxytocin group (6% versus 5.7%, P = 0.85; 153 mL versus 146 mL, P = 0.36). Shivering and pyrexia were encountered more often in the misoprostol than in the oxytocin group (shivering: 19% versus 0.8%, P < 0.001, relative risk [RR] 0.86, 95% confidence interval [CI] 0.82–0.90; pyrexia: 2.3% versus 0%, P = 0.03, RR 0.97, 95% CI 0.95–0.99). Conclusion The efficacy of 400 μg of misoprostol administered sublingually was equivalent to that of 10 units of oxytocin given intramuscularly for prevention of PPH in low-risk vaginal delivery.