Effect of misoprostol versus oxytocin in reducing postpartum hemorrhage after labor induction
Abstract
Introduction: Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that occurs after caesarean section (CS) or normal vaginal delivery (NVD). It may be defined as ≥500 mL hemorrhage after vaginal or ≥1000 mL hemorrhage after CS delivery. PPH is one of the most common obstetric maternal complications and is among the three most common etiologies of maternal death worldwide. Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor. Materials and Methods: The study was a randomized clinical trial carried out at the Department of Gynaecology & Obstetrics, 250 Bedded General Hospital, Noakhali, Bangladesh from July to December 2021. One hundred (100) patients were included. Women with term pregnancy were randomized to receive either 200 µg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage. Results: Total 100 women with term pregnancy in two groups of 50 each were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; (P = 0.11). The mean duration of third stage of labor was similar and the difference was not statistically significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) (P = 0.38), as well as need for additional oxytocics (14.0% vs. 6.0% P = 0.18) misoprostol and oxytocin, respectively. There were no differences at the 5% level of significance between groups with regard to the incidence of PPH (20.0% vs. 14.0% respectively; P=0.43). Among the women who were recruited (safety population), the frequencies of the expected side effects did not differ significantly between the two groups. In misoprostol group, side effects were shivering, fever, nausea and abdominal pains, while the oxytocin group abdominal pains, headaches and shivering. Conclusion: Misoprostol administered in the third stage of labor after labor induction by Oxytocin showed a trend towards significantly reducing postpartum blood loss and incidence of postpartum hemorrhage. Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 µg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor.
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