Management Of Third Stage Research Articles

Expression of Concern: Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage.

Expression of Concern: Carbetocin versus rectal misoprostol for management of third stage of labor among women with low risk of postpartum hemorrhage.

Spontaneous vaginal birth after multiple previous caesarean sections: A case report and literature review

Background: Vaginal birth after caesarean section (VBAC) is increasingly recognized as a safe and effective option for women with a history of Caesarean deliveries. However, limited attention has been given to feasibility and safety of VBAC after multiple caesarean sections. Case presentation: A 36-year-old woman with a history of four previous Caesarean sections presented in our centre in third stage of labour. Despite counseling for elective Caesarean section, she had a spontaneous vaginal delivery of a live 2.6 kg female neonate in a vehicle en route to the hospital. On arrival, she was stable but had lost about 500ml of blood. Immediate interventions included active management of third stage of labour and assessment for perineal injuries, with subsequent monitoring and blood transfusion. She had a normal postpartum recovery, was discharged after four days, and had a reassuring 6-week post-natal visit, with a referral to family planning. Conclusion: This case underscores the potential success and safety of vaginal birth after multiple (three or more) Caesarean sections, challenging the notion that a history of repeated C-sections precludes this option. Vaginal birth after CS (VBAC), initially restricted to one previous CS, is now considered in selected cases with two prior abdominal deliveries. However, the acceptance of VBAC after three or more CS remains limited despite available evidences indicating comparable success rates and maternal risks for VBAC after multiple CS when compared to VBAC after one prior CS or elective repeat CS.

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied. This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery. In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor. Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40-0.90) in group A and 0.60 g% (interquartile range, 0.40-0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group. The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery. El resumen está disponible en Español al final del artículo.

Quality of hospital labour and delivery care: A multilevel analysis in Southern Nations and Nationalities People's Region of Ethiopia.

Ethiopia has one of the highest maternal mortality ratios in Africa. Few have examined the quality of labour and delivery (L&D) care in the country. This study evaluated the quality of routine L&D care and identified patient-level and hospital-level factors associated with the quality of care in a subset of government hospitals. This was a facility-based, cross-sectional study using direct non-participant observation carried out in 2016. All mothers who received routine L&D care services at government hospitals (n = 20) in one of the populous regions of Ethiopia, Southern Nations Nationalities and People's Region (SNNPR), were included. Mixed effects multilevel linear regression modeling was employed in two stages using hospital as a random effect, with quality of L&D care as the outcome and selected patient and hospital characteristics as independent variables. Patient characteristics included woman's age, number of previous births, number of skilled attendants involved in care process, and presence of any danger sign in current pregnancy. Hospital characteristics included teaching hospital status, mean number of attended births in the previous year, number of fulltime skilled attendants in the L&D ward, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent to which the hospital met the 2014 Ethiopian Ministry of Health standards regarding to resources available for providing quality of L&D care (measured on a 0-100% scale). These standards pertain to availability of human resource by category and training status, availability of essential drugs, supplies and equipment in L&D ward, availability of laboratory services and safe blood, and availability of essential guidelines for key L&D care processes. On average, the hospitals met two-thirds of the standards for L&D care quality, with substantial variation between hospitals (standard deviation 10.9 percentage points). While the highest performing hospital met 91.3% of standards, the lowest performing hospital met only 35.8% of the standards. Hospitals had the highest adherence to standards in the domain of immediate and essential newborn care practices (86.8%), followed by the domain of care during the second and third stages of labour (77.9%). Hospitals scored substantially lower in the domains of active management of third stage of labour (AMTSL) (42.2%), interpersonal communication (47.2%), and initial assessment of the woman in labour (59.6%). We found the quality of L&D care score was significantly higher for women who had a history of any danger sign (β = 5.66; p-value = 0.001) and for women who were cared for at a teaching hospital (β = 12.10; p-value = 0.005). Additionally, hospitals with lower volume and more resources available for L&D care (P-values < 0.01) had higher L&D quality scores. Overall, the quality of L&D care provided to labouring mothers at government hospitals in SNNPR was limited. Lack of adherence to standards in the areas of the critical tasks of initial assessment, AMTSL, interpersonal communication during L&D, and respect for women's preferences are especially concerning. Without greater attention to the quality of L&D care, regardless of how accessible hospital L&D care becomes, maternal and neonatal mortality rates are unlikely to decrease substantially.

Active Versus Expectant Management of Third Stage of Labor: A Plane of Nursing Action

Active Versus Expectant Management of Third Stage of Labor: A Plane of Nursing Action

A randomized controlled study comparing oral misoprostol with intramuscular oxytocin in active management of third stage of labour.

The study aimed to compare the effectiveness and side effects of 600 μg of oral Misoprostol with 10 international units (IU) intramuscular oxytocin in managing the third stage of labor. This open-label, randomized controlled trial included 260 low-risk women in the second stage of labor with anticipated vaginal delivery. They were randomly assigned, to receive either 600 μg of misoprostol orally or 10 IU of oxytocin intramuscularly. The primary outcomes were blood loss during delivery and incidence of postpartum hemorrhage, evaluated using intention-to-treat analysis. Significance was set at P≤0.05. Baseline characteristics were similar in both groups (P>0.05). The misoprostol group had a significantly lower blood loss than that of the oxytocin group (306.57±176.44 mL vs. 349.37±135.50 mL; relative difference, -12.251 [95% confidence intervals [CI], -22.528 to -1.575]; P=0.012). Incidence of postpartum hemorrhage was similar in both the groups (relative risk [RR], 0.952 [95% CI, 0.543 to 0.671]; P=0.865). Additional oxytocic therapy requirement was also comparable (RR, 1.143 [95% CI, 0.671 to 1.947]; P=0.623). Nausea, shivering, and mean increase in temperature were significantly more common in the misoprostol group than in the oxytocin-parturient group. In this study, 600 μg oral misoprostol was superior to intramuscular 10 IU oxytocin in reducing blood loss at birth, and equally effective in preventing postpartum hemorrhage. However, misoprostol exhibited more side effects compared to that of oxytocin.

Comparison of intravenous carbetocin versus intramuscular oxytocin in management of third stage of labour in vaginal delivery

Comparison of intravenous carbetocin versus intramuscular oxytocin in management of third stage of labour in vaginal delivery

Assessment of Skills of Health Care Professionals Posted in Labour Room and Maternity OTs Based on OSCE (Objective Structured Clinical Examination) Using LaQshya Guidelines

Background: Present study attempts to assess the skills of staff including Doctors and nurses posted in labourroom and maternity OTs based on OSCE (Objective Structured Clinical Examination) as mentioned in LaQshyaguidelines in selected areas of Indore and Ujjain district (M.P) regarding the management of normal labour, theactive management of third stage of labour, Newborn Resuscitation, management of PPH due to atonic uterus andmanagement of eclampsia. Even in these parameters many sub-parameters were studied.Materials and Methods: Pre designed semi structured Observation checklist for Health care providers regardingskill assessment of the staff based on OSCE guideline was used to assess Health care providers including Doctors,Staff nurses/ANMs, who are providing MCH services in LR (Labour room) and maternity OT of the selectedhospitals of Indore and Ujjain district.Results: Most of the manoeuvres were better performed by staff nurses posted in CHCs rather than those postedin PHCs. Breathing assessment of baby was lacking among staff nurses of both CHCs and PHCs and needed to betackled with by a reorientation training of paramedical staff in critical care. Decision to transfer (is usually afterConsultation with the in charge, hence it is usually the Medical officers prerogative) and bimanual compression/aortic compression/condom tamponade to control bleeding was done exclusively by MOs.Conclusion: OSCE helped to assess the skills of the staff of maternity wing in a comprehensive manner and waswell appreciated by the staff. Such OSCE modules should be developed and regularly used and updated to assessthe clinical skill of the staff in the maternity wing of any health centre or hospital.

A comparative study between misoprostol combined with oxytocin versus oxytocin alone in reducing post-partum blood loss

Background: Oxytocin remains as the first line utero-tonic drug used in the management of postpartum hemorrhage (PPH). Because of its certain disadvantages, another cost effective uterotonic drug which can be used orally or vaginally with good absorption is misoprostol, which is a prostaglandin E1 analogue. The study aimed to compare and evaluate the effectiveness of oxytocin versus oxytocin plus misoprostol in the prevention of PPH. Materials and methods: A prospective randomized interventional study was conducted on 160 term pregnant women from February 2019 to August 2019. The study subjects were randomized into two groups of 80 each. During the active management of third stage of labour, all patients in the study group were administered with standard drug treatment of 10 IU of oxytocin through intramuscular route along with 600µg of misoprostol given sublingually, whereas the patients in the control group were given only 10IU of oxytocin alone. Results: The average postpartum blood loss and the need for blood transfusion were significantly higher among the control group compared to the study group. The overall incidence of PPH was found to be 28.5% among the control group and it was 6.4% among the study group. Adverse events such as fever, shivering, nausea, vomiting and diarrhoea were more among the study group than that of the control. Conclusion: A single dose of 600µg of sublingual misoprostol as an adjunct to standard 10 units of intramuscular oxytocin was found to be more effective in reducing blood loss than using 10 units of intramuscular oxytocin alone in the Active Management of Third Stage of Labour.

A study to assess the knowledge, expressed practice and attitude on an active management of third stage of labour (AMTSL) among fourth year B.Sc. nursing students of selected nursing colleges of Gujarat state

A study to assess the knowledge, expressed practice and attitude on an active management of third stage of labour (AMTSL) among fourth year B.Sc. nursing students of selected nursing colleges of Gujarat state

Engaging National Professional Society to Combat Postpartum Hemorrhage Using Bundle Approach - A FIGO-SAFOG-OGSB-MGH Project: Experience of Implementation in Bangladesh

Objective: To reduce the incidence and death due to post-partum Hemorrhage (PPH) and capacity building of health service providers by using PPH Emergency response using Bundle Approach. Method: Planning and implementation of WHO formulated PPH Bundles [Active Management of Third Stage of Labour (AMTSL), First response Bundle and Refractory PPH Bundle] by Obstetrical and Gynaecological Society of Bangladesh (OGSB) in 14 different levels of public and private hospitals in Bangladesh. After discussion with International Federation of Gynaecology and Obstetrics (FIGO) and South Asian Federation of Obstetrics and Gynaecology (SAFOG) team, a Memorandum of understanding (MOU) was signed; permission from Ministry of Health and Family welfare (MOHFW) was obtained through Directorate General of Health Services (DGHS) and also from all the institutions. The project period was from November 2019 to September 2022 in a spoke-and-hub fashion. A group of master trainers and a technical advisory group were developed comprising of senior obstetricians and gynecologist of Bangladesh. Data were obtained through record keeping of the respective hospitals and Management Information System (MIS) of DGHS, monitoring was done by OGSB and Massachusetts General Hospital (MGH)-FIGO team. Results: Consultative and planning meetings were organized among OGSB, FIGO, SAFOG and MGH: 16 master trainers, 74 trainers were produced and 740 health service providers (Doctor, Nurses, midwives) and 450 non clinical staffs were trained. All clinical and nonclinical bundles were implemented in 14 facilities in spoke-and-hub fashion. Occurrence of PPH, detection rate of PPH, filling up PPH checklist and debrief forms were improved. Data collection system, understanding about data improved a lot. Facility readiness, team work, data monitoring &amp; supervision, network integration and leadership skills were instituted and shown excellent positive changes. Regular simulations were continued which helped old &amp; new service providers to learn and continue proper use of the clinical and non-clinical interventions. Scale up was planned and continued. Conclusion: PPH emergency response using bundle approach was found to be an important practical way to reduce occurrence, death and disability related to PPH. Needs for surgery has reduced also. Quality of services improved in terms of providing standard care, record keeping and reporting. Regular supervision and monitoring; data management and personal motivation are the challenges. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 98-108

How midwives facilitate informed decisions in the third stage of labour – an exploration through portraiture

ProblemMidwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. BackgroundPrevious research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. AimTo explore midwives’ experiences of facilitating informed decision-making, using third-stage management as context. MethodsFive midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. FindingsFive individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; ‘informed decision-making is fundamental to midwifery practice’ ‘the system’, and ‘navigating the system’. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and ‘navigating the system’ – contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. Discussion and conclusionMidwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.

Postpartum hemorrhage; A perspective from evidence

Postpartum hemorrhage although highly preventable, it is the leading cause of maternal mortality in both resource abundant countries and resource limited countries, despite the presence of known risk factors every woman has a chance of developing postpartum hemorrhage during delivery, but identification of high-risk women and active management of third stage of labor has been shown to have positive effects in reducing mortality from postpartum hemorrhage.

Postpartum haemorrhage: a review from evidence

Postpartum hemorrhage although highly preventable, it is the leading cause of maternal mortality in both resource abundant counties and resource limited countries, despite the presence of known risk factors every woman has a chance of developing postpartum hemorrhage during delivery, but identification of high-risk women and active management of third stage of labor has been shown to have positive effects in reducing mortality from postpartum hemorrhage.

Prevention of Post-Partum Hemorrhage: Comparison of Oxytocin and Misoprostol. A Two center study in the Bamenda and Nkwen Health Districts

Background: Postpartum hemorrhage is one of the most common obstetrical complications affecting up to 18% of deliveries. Globally, it is responsible for 35 – 55% of peripartum maternal deaths. In Cameroon, the maternal mortality rate is at 406 maternal death per 100,000 live births, with PPH being the leading cause accounting for about 25%. This study aimed to compare the efficacy and safety of misoprostol versus oxytocin in the prevention of postpartum hemorrhage in the Bamenda Health District and Nkwen Health District. Methods: This was a hospital-based randomized clinical trial study in the Bamenda Regional Hospital and Nkwen District Hospital. The study was conducted from March 1st to May 31st 2021 including pregnant women who delivered at the maternity at these two hospitals. All their pregnancy was singleton gestation at term and haven given their informed consent. Women with known history of cardiac, renal, hepatic diseases or any coagulopathy, Cesarean delivery were excluded. We randomized 308 participants in a 1:1 ratio to receive 800 μg of oral misoprostol or 10IU of oxytocin intramuscularly during the active management of third stage of labor (AMSTL). The Hemoglobin (Hb) concentration and hematocrit (HCT) of the participants were measured before and 24hrs after delivery. Our primary outcome of interest was (Post-Partum Hemorrhage) PPH, defined as Hb change ≥ 1g/dl within 24hrs of delivery. Secondary outcomes included; mean Hb change, Hb change ≥2g/dl (severe PPH). Dichotomous outcomes between study groups were compared by estimating crude relative risks (RRs) with 95% confidence intervals. Logistic regression (the chi-square test) was done to determine the factors associated with the occurrence of postpartum hemorrhage, with a level of significance at 5%. Results: After 24hrs, Postpartum hemorrhage (PPH) occurred in 41 (26.6%) and 47 (30.5%) participants in the misoprostol and oxytocin groups respectively (RR= 0.87, 95% C.I= 0.61 - 1.24, p=0.449). Severe postpartum hemorrhage occurred in 3 (1.9%) and 5 (3.2%) participants in the misoprostol and oxytocin groups respectively (RR= 0.6, 95% C.I=0.15 - 2.47, p=0.723). Past history of PPH (aOR=10.1 (3.5 – 28.6), p&lt;0.0001), augmentation of labor (aOR=3.4 (1.6 – 7.1), p=0.0011), fetal birth weight ≥3.5Kg (aOR=2.5 (1.3 – 4.8), p=0.0074) and retained products (aOR= 8.4 (4.2 – 16.7), p&lt;0.0001) were risk factors of PPH. Participants in the misoprostol group more commonly experienced shivering (RR 3.2, 95% CI 2.0 - 5.1, p&lt;0.0001) and nausea/vomiting (RR 35.5, 95% CI 8.9 – 142.2, p&lt;0.0001). Conclusion: Oral misoprostol at the dose of 800μg is as effective as 10 IU IM Oxytocin in the prevention of PPH and is a potent alternative to oxytocin. Most common risk factors of PPH are past history of PPH, augmentation of labor, fetal weight ≥ 3.5kg and retained products. Side effects were mostly associated with 800μg of oral Misoprostol.

Practices and factors associated with active management of the third stage of labor in East Africa: systematic review and meta-analysis

BackgroundActive management of the third stage of labor involves prophylactic uterotonics, early cord clamping, and controlled cord traction to deliver the placenta. It is designed to facilitate the delivery of the placenta by increasing uterine contractions during the third stage of labor. It is also used to prevent postpartum hemorrhage by averting uterine atony.This systematic review and meta-analysis’s emphasis was on the practice and factors associated with active management of the third stage of labor in East Africa.MethodsPubMed, Web of Science, Science Direct (Scopus), Google Scholar, African Journals Online, and the Cochrane Library electronic databases were used. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. A p-value of 0.05 is regarded to indicate potential publication bias: the funnel plot, Begg, and Egger’s regression test were used to examine publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. Pooled analysis was carried out. By country, a subgroup analysis was conducted.ResultsThirteen studies were included in this systematic review and meta-analysis. The pooled prevalence of the practice of active management of the third stage of labor in East Africa was 34.42%. Received training (OR = 6.25, 95%CI = 3.69, 10.58), years of experience (OR = 3.66, 95%CI = 2.35, 5.71), and good knowledge (OR = 3.66, 95%CI = 2.35, 5.71) were statically associated with the practice of active management of third stage of labor.ConclusionThe pooled prevalence of practice for active management of the third stage of labor in East Africa was low. Factors that were statistically associated with the practice were received training, years of experience, and good knowledge. Obstetric care providers should continue to receive training in all components of active management of the third stage of labor through training and education programs.

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE AMONG NURSES ON ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR WORKING IN OBSTETRICS AND GYNAECOLOGY DEPARTMENT IN SELECTED HOSPITALS OF KAMRUP (M), ASSAM.

Background: Active Management of Third Stage of Labour consists of interventions designed to speed the delivery of the placenta by increasing uterine contractions and prevent post-partum hemorrhage by an averting uterine atony. The Objective: objective of the study was to assess the Knowledge and Practice among Nurses on Active Management of Third Stage of Labour in selected hospitals of Kamrup (M), Assam. Methods: The study was conducted using Descriptive Survey design in Gauhati Medical College Hospital and Maternity &amp; Child Welfare Hospital under Kamrup (M), Assam with a total of 82 Nurses by convenience sampling technique. Self - administered structured questionnaire was used to assess the knowledge and practice on Active Management of Third Stage of Labour. Data was analysed by using the software package named SPSS 20 Version. The nding of the study revealed that only 15.8% of the total Nurses have ade Result: quate level of knowledge 17.1% have good practice on Active Management of Third Stage of Labour. Karl Pearson's correlation coefcient was found to be r=0.565** .Thus there is highly signicant positive correlation between the two variables i.e. Knowledge and Practice of Nurses on Active Management of Third Stage of Labour. There was a signicant association between Knowledge on Active Management of Third Stage of Labour with their Professional Qualication and Exposure to any information on Active Management of Third Stage of Labour .The association of Practice was found signicant with their Years of Working Experience in Obstetrics and Gynaecology Department and Exposure to any information on Active Management of Third Stage of Labour. Conclusion: Knowledge and Practice among Nurses on Active Management of Third stage of Labour in the selected hospitals was low

The Management of Third Stage of Labor

Doğum eylemi ve doğumun evrelerinde uygulanan çeşitli uygulamalar geçmişten günümüze kadar tartışılmaktadır ve bu konu halen popülaritesini korumaktadır. Anne ve bebeğin iyilik halinin sağlanması ve sürdürülebilmesi için doğumda yapılan her uygulamanın kanıt temelli olması gerekmektedir. Bu çerçevede doğum eyleminin üçüncü evresinde uygulanan umblikal kordun klemplenme zamanı, uterotonik ajan kullanımı, umblikal kordun traksiyonu, uterin masaj gibi uygulamalar literatür çalışmalarıyla incelenmektedir. Bu uygulamaların etkinliğini bilmek, doğumda birincil rol oynayan ebelerin gereksiz uygulamalardan kaçınmasını sağlayacak ve var olan bilgilerini yeni bilgilerle bütünleştirecektir. Bu derlemede, doğum eyleminin üçüncü evresinin yönetiminde kullanılan uygulamalar ve kanıta dayalı yaklaşımlar literatür bilgisiyle sunulmaktadır.

Effect of Training Program on Midwife's Knowledge and Practice Regarding Evidence Based Practice for Active Management of Third Stage of Labor in Al Tahreer Maternity Hospital in Gaza strip, Palestine.

The third stage of labor is considered to be the most dangerous stage for the bearing woman due to the threat of bleeding. Midwife is frontline to give care, by using active operation of third stage of labor which as evidence based technique. This study was aimed to evaluate the effect of training program on midwives’ knowledge and practice regarding evidence based practice of active management of third stage of labor in Al Tahreer maternity hospital. This study was aimed to estimate the effect of training program on midwives ’ knowledge and practice regarding evidence based practice of active operation of third stage of labor in Al Tahreer maternity hospital. Keywords: Midwife, Knowledge, practice, Evidence, Active management, Third stage.

A Comparative Study of Sublingual Misoprostol Versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor.

Objective Misoprostol has attracted low-income low-resource countries for the active management of the third stage of labor. The objective of this study was to compare the efficacy of sublingual misoprostol and intramuscular oxytocin in the active management of the third stage of labor. Study design This was a prospective randomized controlled trial in which a total of 407 healthy pregnant women having singleton pregnancy, cephalic presentation, and normal vaginal delivery were divided into two groups. In the first group (n=203), women received 600 µg misoprostol tablet sublingually, and in the second group (n=204), women received 10 IU of intramuscular oxytocin, within 1 minute of the delivery of the baby during the third stage of labor. Three patients from the first group and four patients from the second group were excluded from the analysis due to traumatic postpartum hemorrhage (PPH). The primary outcome was an incidence of PPH. Secondary outcomes were the duration of the third stage of labor, amount of blood loss, fall in hemoglobin concentration after 48 hours of delivery, need for additional uterotonics, and side effects of the drugs. Data were compared using the chi-square and independent samples t-test. Results The incidence of PPH was 6.5% in the misoprostol group as compared to 2% in the oxytocin group (p=0.026). The misoprostol group also had significantly higher blood loss (293.75±125.8 mL) and a greater fall in hemoglobin level (0.58±0.25 g/dL) as compared to that in the oxytocin group (226.13±98.44 mL and 0.45±0.20 g/dL) (p<0.001). The mean duration of the third stage of labor was significantly higher in the misoprostol group (5.31±2.1 min) as compared to that in the oxytocin group (3.65±1.75 min) (p<0.001). The additional need for uterotonics was recorded in 15% of the study participants in the misoprostol group as compared to 8% in the oxytocin group (p=0.028). The incidence of side effects such as shivering and fever was significantly higher in the misoprostol group as compared to the oxytocin group. No significant difference between the two groups was observed concerning the incidence of nausea, vomiting, diarrhea, and headache. Conclusion Intramuscular oxytocin is a safe and useful alternative to sublingual misoprostol in facilitating the third stage of labor with minimal blood loss, fewer incidences of hemorrhage, and fewer adverse effects.