A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2alpha in active management of third stage of labor.
OBJECTIVE
To compare the efficacy and side effects of 0.2 mg methyl-ergometrine IM, 400 microg misoprostol sublingual and 125 microg 15 methyl PGF2alpha IM in active management of third stage of labor.


METHODS
Two hundred low risk pregnant women with induced or spontaneous labor were randomized to receive either 400 microg misoprostol sublingually or 0.2 mg methyl-ergometrine intramuscularly or 125 microg 15-methyl PGF2alpha intramuscularly, after the delivery of anterior shoulder of baby. The main outcome measures were: blood loss more than 500 ml, need for additional oxytoxic drug, change in hemoglobin level and side effects due to drugs.


RESULTS
The median estimated blood loss, blood loss more than 500 ml, need for additional oxytocic drug and change in hemoglobin levels were similar in all three groups. The significant side effects in the misoprostol group were shivering, pyrexia (temperature > 38 degrees C) and vomiting, which were self-limiting. Diarrhea was significantly more in the 15 methyl PGF2alpha group. Three women in methyl-ergometrine group underwent manual removal of placenta. One woman in misoprostol group received blood transfusion.


CONCLUSIONS
Sublingual misoprostol appears to be as effective as intramuscular methyl-ergometrine and intramuscular 15-methyl PGF2alpha in the prevention of postpartum hemorrhage. It can be a good alternative in resource poor setting.
Vaid
Arvind
A
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Dadhwal
Vatsla
V
Mittal
Suneeta
S
Deka
Deepika
D
Misra
Renu
R
Sharma
Jai Bhagwan
JB
Vimla
N
N
D000286:Administration, Sublingual; D000328:Adult; D001724:Birth Weight; D002260:Carboprost / Q000008:administration & dosage* / Q000009:adverse effects; D004874:Ergonovine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D007749:Labor Stage, Third / Q000187:drug effects*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies
D010120:Oxytocics; D016595:Misoprostol; D002260:Carboprost; D004874:Ergonovine