A pilot-randomized comparison of sublingual misoprostol with syntometrine on the blood loss in third stage of labor.
BACKGROUND
To compare sublingual misoprostol with intravenous syntometrine use during third stage of labor by measuring the blood loss.


METHODS
Sixty women were randomized to receive either 600 micro g misoprostol sublingually or 1 ml syntometrine intravenously during the third stage of labor after spontaneous vaginal delivery. For those with risk factors of postpartum hemorrhage such as medical induction or augmentation of labor, previous third stage complications were excluded. The blood loss in labor was measured by the alkaline-hematin method, and differences in hemoglobin before and after delivery were compared.


RESULTS
There was no significant difference in the median measured blood loss between the misoprostol group and the syntometrine group (280 versus 226 ml, p = 0.45). The change in hemoglobin was comparable between the two groups. There were more women in the misoprostol group who required additional oxytocics, but the difference was not statistically significant. A major complication occurred in one patient in the misoprostol group with blood loss in excess of 1000 ml. The incidence of side effects such as shivering and pyrexia in women receiving misoprostol was significantly higher than that in the syntometrine group.


CONCLUSIONS
The use of sublingual misoprostol or intravenous syntometrine in spontaneous vaginal delivery resulted in a comparable amount of blood loss. Transient side effect such as fever and shivering which resolved within a day occurred more frequent to those who received sublingual misoprostol.
Lam
H
H
Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong SAR, China. lamswh@yahoo.com.hk
Tang
O S
OS
Lee
C P
CP
Ho
P C
PC
D000286:Administration, Sublingual; D000328:Adult; D004874:Ergonovine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007275:Injections, Intravenous; D007749:Labor Stage, Third; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D049590:Postpartum Period / Q000097:blood; D011247:Pregnancy; D013997:Time Factors
D006454:Hemoglobins; D010120:Oxytocics; D016595:Misoprostol; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine