Comparison of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor.
OBJECTIVE
To compare the efficacy and adverse effects of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor (AMTSL).


METHODS
A double-blind randomized trial of 300 women with a healthy singleton pregnancy allocated into 4 groups to receive either: 400 microg or 600 microg of sublingual misoprostol, 5 IU of intravenous oxytocin, or 200 microg of intravenous methylergometrine. The primary outcome measure was blood loss in the third and fourth stage of labor; secondary measures were duration of the third stage of labor, changes in hemoglobin levels, and adverse effects.


RESULTS
Patients who received 600 microg of misoprostol had the lowest blood loss (96.05+/-21.1 mL), followed by 400 microg of misoprostol (126.24+/-49.3 mL), oxytocin (154.7+/-45.7 mL), and methylergometrine (223.4+/-73.7 mL) (P<0.01). Shortest mean duration of the third stage of labor (5.74 minutes) was with 600 microg of misoprostol, while methylergometrine had the longest (6.83 minutes) (P<0.05). Pyrexia was observed in the misoprostol groups, and raised blood pressure in the methylergometrine group (P<0.001). The 24-hour postpartum hemoglobin level was similar among the groups (P>0.05).


CONCLUSIONS
Administration of 600 microg of sublingual misoprostol was more effective than 400 microg of misoprostol, intravenous oxytocin, and intravenous methylergometrine for AMTSL.
Singh
Gunjan
G
Department of Obstetrics and Gynecology, University College of Medical Sciences, Guru Teg Bahadur Hospital, New Delhi, India. drgunjansingh@gmail.com
Radhakrishnan
Gita
G
Guleria
Kiran
K
D000286:Administration, Sublingual; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000139:chemically induced; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007749:Labor Stage, Third / Q000187:drug effects; D008755:Methylergonovine / Q000008:administration & dosage / 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 / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
D006454:Hemoglobins; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D008755:Methylergonovine