Oral misoprostol versus oxytocin in the management of the third stage of labour.
OBJECTIVE
To compare the effects of oral misoprostol 800 mug with intramuscular oxytocin 10 IU in routine management of the third stage of labour.


METHODS
This randomized controlled trial was performed in a rural district hospital in Ghana, West Africa, and enrolled women in labour with anticipated vaginal delivery and no known medical contraindication to prostaglandin administration. Women were randomized to receive oral misoprostol 800 mug or intramuscular oxytocin 10 IU. Blood samples were taken to determine hemoglobin concentration before delivery and at 12 hours post partum. Treatment was administered at delivery of the anterior shoulder. The primary outcome was the change in hemoglobin concentration from before to after delivery. Secondary outcomes included other measures of blood loss and presumed medication side effects.


RESULTS
In total, 450 women were enrolled in the study. Their baseline characteristics were similar. There was no significant difference between the groups in the change in hemoglobin concentration (misoprostol 1.07 g/dL and oxytocin 1.00 g/dL). The only significant secondary outcomes were shivering (80.7% with misoprostol vs. 3.6% with oxytocin) and pyrexia (11.4% with misoprostol, none with oxytocin).


CONCLUSIONS
Routine use of oral misoprostol 800 microg appears to be as effective as 10 IU parenteral oxytocin in minimizing blood loss during the third stage of labour, as determined by change in hemoglobin concentration. Misoprostol appears to be a safe, inexpensive, and effective uterotonic for use in rural and remote areas, where intravenous oxytocin may be unavailable.
Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's NL.
Steven M
SM
Parsons
Matercare International, St. John's NL.
Robert L
RL
Walley
Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's NL.
Joan M G
JMG
Crane
Matercare International, St. John's NL.
Kay
K
Matthews
Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's NL.
Donna
D
Hutchens
D000284:Administration, Oral; D000328:Adult; D003906:Developing Countries; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000139:chemically induced; D005869:Ghana; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007273:Injections, Intramuscular; D007749:Labor Stage, Third / Q000187:drug effects*; D016595:Misoprostol / Q000008:administration & dosage / Q000494:pharmacology*; D010120:Oxytocics / Q000008:administration & dosage / Q000494:pharmacology*; D010121:Oxytocin / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D012768:Shivering / Q000187:drug effects; D016896:Treatment Outcome
D006454:Hemoglobins; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin