Sublingual misoprostol versus intravenous oxytocin in prevention of post-partum hemorrhage

Abstract

Post-partum hemorrhage (PPH) is the most common direct cause of maternal mortality and timely intervention can save many lives. To compare the effectiveness of sublingual misoprostol to intravenous oxytocin in preventing post-partum hemorrhage in low risk vaginal birth. One hundred patients with no risk factor for PPH were randomly allocated to receive 600μg misoprostol administered sublingually or 10IU of intravenous oxytocin immediately after the delivery of baby. Main outcome measures were post-partum blood loss, drop in hemoglobin in 24h, duration of third stage of labor, and drug-related adverse effects. Mean age, parity and gestational age were similar in both groups. Mean blood loss was significantly lower in oxytocin group (114.28±26.75 versus 149.50±30.78ml; p=0.00). Drop in hemoglobin was 0.31±0.16 versus 0.49±0.21g% (p=0.01) in oxytocin and misoprostol group, respectively. Duration of third stage labor was shorter in oxytocin group (median 5min, IQR: 4.5-5.5 versus 5.5min, IQR: 5-6min, p<0.01). Although fever and shivering were common adverse effects with misoprostol but were not clinically significant. Intravenous oxytocin is more efficacious than sublingual misoprostol in preventing PPH in institutional deliveries.