Oral misoprostol versus intramuscular oxytocin in the active management of the third stage of labour

Afolabi EO, Kuti O, Orji EO, Ogunniyi SO
Correspondence: Dr Ernest O Orji, eoorji11@yahoo.com

ABSTRACT
Introduction Although the third stage of labour is usually uneventful, several significant complications may be encountered that may lead to maternal morbidity and mortality, especially primary postpartum haemorrhage. The objective of this study was to compare 400 µg oral misoprostol with 10 IU intramuscular oxytocin in the active management of the third stage of labour.
Methods This was a prospective randomised controlled clinical trial in which 200 parturients at term who had vaginal delivery were randomly assigned into two groups: oral misoprostol and intramuscular oxytocin, after the delivery of the baby and the clamping of the umbilical cord. The primary outcome was the incidence of primary postpartum haemorrhage. Secondary outcomes included a drop in haemoglobin concentration 48 hours after delivery, the need for extra oxytocics, duration of the third stage of labour and side effects of the oxytocics. These results were subjected to statistical analysis using chi-square test or student’s t-test.
Results No occurrence of primary postpartum haemorrhage or significant difference in the drop in haemoglobin concentration levels was reported after delivery (p-value is 0.49), and no significant differences were observed in other secondary outcome measures with the exception of nausea, which occurred solely in the misoprostol group (4 percent, p-value is 0.04).
Conclusion Oral misoprostol appeared to be as effective and as safe as intramuscular oxytocin in the active management of the third stage of labour.

Keywords: intramuscular oxytocin, oral miso-prostol, third stage of labour
Singapore Med J 2010; 51(3): 207-211