Randomized controlled trial of rectal misoprostol versus oxytocin in third stage management.
OBJECTIVE
To compare rectal misoprostol with oxytocin for routine management of the third stage of labour.


METHODS
A total of 240 parturient women were randomized, at three University of Toronto teaching hospitals, to receive either rectal misoprostol (400 microg) after delivery of the infant or parenteral oxytocin (5 units i.v. or 10 units i.m.) with the delivery of the anterior shoulder, when possible, or 5 units i.v. or i.m after the delivery of the placenta. The primary outcome measure was change in hemoglobin (Delta[Hgb]) from admission in early labour to day one postpartum.


METHODS
The labour ward of three University of Toronto teaching hospitals: St. Michael's, Toronto General, and Mount Sinai.


METHODS
Labouring women either nulliparous or multiparous with no known risk for excessive third stage blood loss; vertex presentation; no previous Caesarean delivery; induced, spontaneous, or augmented labour.


RESULTS
No difference in Delta[Hgb] was observed between the two groups; the Delta[Hgb] in the oxytocin and misoprostol groups were 1.43 g/L (95% confidence interval [CI], 1.2-1.6 g/L) and 1.59 g/L (95% CI, 1.4-1.8 g/L) respectively (p = 0.35). Secondary outcome measures (excessive third stage bleeding, duration of third stage of labour, need for manual removal of the placenta or the need for additional oxytocics) did not differ between the two groups.


CONCLUSIONS
Rectal misoprostol is of equivalent efficacy to parenteral oxytocin for the prevention of primary postpartum hemorrhage. Rectal misoprostol is an appropriate uterotonic agent for routine management of the third stage of labour.
University of Toronto, Toronto, ON.
Sami G
SG
Karkanis
David
D
Caloia
Mary Ellen
ME
Salenieks
John
J
Kingdom
Mark
M
Walker
Filomena
F
Meffe
Rory
R
Windrim
D000285:Administration, Rectal; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007749:Labor Stage, Third; D016595:Misoprostol / Q000627:therapeutic use*; D007744:Obstetric Labor Complications / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*
D006454:Hemoglobins; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin