Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial.
OBJECTIVE
The purpose of this study was to compare misoprostol 600 microg intrarectally with conventional oxytocics in the treatment of third stage of labor.


METHODS
In a controlled trial, 1606 women were randomly grouped to receive (1) oxytocin 10 IU plus rectal misoprostol, (2) rectal misoprostol, (3) oxytocin 10 IU, and (4) oxytocin 10 IU plus methylergometrine. The main outcome measures were the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 hours after delivery.


RESULTS
The incidence of postpartum hemorrhage was 9.8% in the group that received only rectal misoprostol therapy compared with 3.5% in the group that received oxytocin and methylergometrine therapy (P =.001). There were no significant differences among the 4 groups with regard to a drop in hemoglobin concentrations. Significantly more women needed additional oxytocin in the group that received only rectal misoprostol therapy, when compared with the group that received oxytocin and methylergometrine therapy (8.3% vs 2.2%; P <.001). The primary outcome measures were similar in the group that received only rectal misoprostol therapy and the group that received only oxytocin therapy.


CONCLUSIONS
Rectal misoprostol is significantly less effective than oxytocin plus methylergometrine for the prevention of postpartum hemorrhage.
Calişkan
Eray
E
Social Security Council: Maternity and Women's Health Teaching Hospital, Ballibaba sok. No: 86/3, 06660 Küçükesat, Ankara, Turkey. eray68@hotmail.com
Meydanli
M Mutlu
MM
Dilbaz
Berna
B
Aykan
Burcu
B
Sönmezer
Meral
M
Haberal
Ali
A
D000285:Administration, Rectal; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D007749:Labor Stage, Third / Q000187:drug effects*; D008755:Methylergonovine / Q000009:adverse effects / Q000627:therapeutic use; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010121:Oxytocin / Q000009:adverse effects / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy
D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D008755:Methylergonovine