Misoprostol versus Oxytocin in Prevention of Postpartum Hemorrhage

Study background: The present study was done to compare oxytocin and misoprostol in active management of third stage of labor. Materials and methods: Total of 200 pregnant women were enrolled in the study were divided into two randomized groups. Group ‘A’ included 100 primigravidas with singleton pregnancy and normal vaginal delivery, who received 600μg misoprostol sublingually with delivery of baby. Group ‘B’ included equal number of primigravidas with singleton pregnancy, who underwent normal vaginal delivery and received 10 IU intramuscular oxytocin after delivery of anterior shoulder of baby. Results: The fall in hemoglobin was ≥ 1 g/dl in 6% of oxytocin group and 8% of misoprostol group and mean blood loss was comparable in the two groups (p = 0.455). None of the cases had mean amount of blood loss ≥ 1000 ml. Incidence of postpartum hemorrhage within an hour of delivery in misoprostol and oxytocin group was 8% and 6% respectively which was comparable (p = 0.435). Occurrence of nausea, vomiting, diarrhea, were also not significantly different between groups (p = 0.102, 0.071, 0.700 respectively) while fever (≥ 38 oC) and shivering was significantly present more in misoprostol group (p = 0.001). Vertigo was present in 2% of misoprostol and 3% of oxytocin group and the difference was not significant (p = 0.651). Conclusions: Misoprostol and oxytocin both were equally effective in prevention of postpartum hemorrhage Though shivering and pyrexia are its specific side effect but they were transient; thus Misoprostol appears to be a safe, inexpensive, thermostable, long shelf life without special storage and effective uterotonic for use in rural and remote areas where parentral oxytocin may be unavailable. It can be given to birth attendants for routine use in third stage of labor especially in rural settings. labor room, Department of Obstetrics and Gynecology, PGIMSR, ESIC during one year period from November 2009 to November 2010. 200 pregnant women were enrolled and were divided into two groups. Group ‘A’ included 100 pregnant women who were primigravidas with singleton pregnancy, and underwent normal vaginal delivery. They received 600 μg misoprostol sublingually as soon as baby was delivered. Group ‘B’ included 100 pregnant women who were primigravidas with singleton pregnancy, and underwent normal vaginal delivery. They received 10 IU intramuscular oxytocin with the delivery of anterior shoulder of baby. Inclusion criteria was all primigravidas with singleton pregnancy who had normal vaginal delivery and exclusion criteria was multiparous women, multiple gestations, medical disorder, uterine malformation, induced labor and use of other uterotonic agents. After detailed patient’s history and examination women fulfilling the inclusion criteria were enrolled in the study group with written informed consent. Normal hematological investigations were done including hemoglobin and hematocrit at the time of admission and 48 hours after delivery. When vaginal delivery was eminent, episiotomy was given before delivery of baby and the doctor picked an envelope for assigning the particular group and sequentially numbered sealed envelopes were kept indicating the method of treatment of third stage of labor to which the women was allocated. Each envelope had a card with instruction for either group. Those marked with “M” indicated randomization to receive 600 μg misoprostol sublingually immediately after birth of the baby and after division of umbilical cord (Group A). Cards marked with “O’ indicated randomization to the standard policy of giving intramuscular 10 Pratiksha Gupta*, Sunita Jindal and Chandna Shekhar Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and research, India *Address for Correspondence Pratiksha Gupta, MD, Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and research, ESIC Model Hospital, Basaidarapur, Ring Road, New Delhi-110015, India, Tel: +919871128703; E-mail: [email protected] Submission: 08 February, 2016 Accepted: 25 March, 2016 Published: 29 March, 2016 Copyright: © 2016 Gupta P, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reviewed & Approved by: Dr. Suresh Ramaswamy, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, USA Dr. Ossama Elsaccar, Department Of Obstetrics & Gynecology, West Virginia University School of Medicine, USA Research Article Open Access