Sublingual Misoprostol versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor

Abstract

Objective: To compare the efficacy and safety of 400 �gm of sublingual misoprostol with 10 units of intramuscular oxytocin in activemanagement of the third stage labor.Methods: The study was carried on 200 women undergoing vaginal delivery who were randomized alternatively into two groups of 100women each. Group 1 (misoprostol group) received 400 �gm misoprostol sublingually and group 2 (oxytocin group) received injectionoxytocin 10 units intramuscularly immediately after the delivery of the baby. Primary outcomes measures were amount of blood loss anddrop in hemoglobin level. Secondary outcomes were need for additional oxytocics, manual removal of placenta, operative intervention forPPH, and side effects of the drugs. The blood loss was measured by clinical estimation by weighing the linen, sponges and pads beforeand after the delivery. Duration of the third stage of labor, need for manual removal of placenta and the use of additional uterotonics, ifrequired, were noted. One hour after the delivery, the women were asked about the side effects of the drugs like nausea, vomiting,headache, chest pain, fever, shivering, etc. Hemoglobin estimation was done at time of admission and 24 hours after the delivery. At theend of the study, the data was analyzed using student �t� test and Chi-square test.Results: The mean age was 23.44 � 3.11 years and 23.78 � 2.47 years in group 1 and 2 respectively. There was no statistically significantdifference in the duration of third stage of the labor and mean fall in hemoglobin level in the two groups ( p > 0.05). The mean blood loss was260.35 � 97.45 ml in the misoprostol group and 264.20 � 103.68 ml in oxytocin group and the difference was not statistically significant.Conclusion: It is concluded from the present study that sublingual misoprostol is as effective as intramuscular oxytocin in activemanagement of third stage of labor and a good option especially for developing tropical countries like India where most of the deliveries areconducted at periphery by a nurse, midwife or a trained dai, and it is difficult to maintain the temperature chain.