A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-ergometrine and Ergometrine–Oxytocin in Reducing Blood Loss in Active Management of 3rd Stage of Labor

Original Article

Abstract

Objectives

The purpose of the study was to compare the efficacy of misoprostol 400 μg per rectally, injection oxytocin 10 IU intramuscular, injection methylergometrine 0.2 mg intravenously and injection (0.5 mg ergometrine + 5 IU oxytocin) intramuscular on reducing blood loss in third stage of labor, duration of third stage of labor, effect on haemoglobin of the patient, need of additional oxytocics or blood transfusion and associated side effects and complications.

Study Design

A prospective non-randomized uncontrolled study was carried out in the Department of Obstetrics and Gynecology, SSG Hospital and Medical College, Baroda enrolling 200 women and dividing them into four groups. Active management of 3rd stage of labor was done using one of the 4 uterotonics as per the group of the patient. The main outcome measures were the amount of blood loss, the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 h after delivery.

Results

Methylergometrine was found to be superior to rest of the drugs in the study with lowest duration of third stage of labor (P = 0.000096), lowest amount of blood loss (P = 0.000017) and lowest incidence of PPH (P = 0.03). There was no significant difference in the pre-delivery and the post-delivery hemoglobin concentration amongst the four groups with P = 0.061. The need of additional oxytocics and blood transfusion was highest with misoprostol as compared to all other drugs used in the study with P = 0.037 and 0.009, respectively. As regards side effects, misoprostol was associated with shivering and pyrexia in significantly high number of patients as compared to the other drugs used in the study while nausea, vomiting and headache were more associated with methylergometrine and ergometrine–oxytocin. However all the side effects were acceptable and preferable to the excessive blood loss.

Conclusion

Methylergometrine has the best uterotonic drug profile amongst the drugs used, strongly favouring its routine use as oxytocic for active management of third stage of labor. Misoprostol was found to cause a higher blood loss compared to other drugs and hence should be used only in low resource setting where other drugs are not available. The role of misoprostol in third stage of labor needs larger studies to be proved.

Keywords

Uterotonics 3rd stage of labor Post-partum hemorrhage Brass-V drapes 

References

  1. 1.
    Maughan KL, Heim SW, Galazka SS. Preventing post-partum hemorrhage: managing the third stage of labour. AAFP. 2006;73(6):1025–8.Google Scholar
  2. 2.
    Fenton JJ, Baumeister LM, Fogarty J. Active management of third stage of labour among American Indian women. Fam Med. 2005;37(6):410–4.PubMedGoogle Scholar
  3. 3.
    Justus Hofmeyr G, Sandra Ferreira V, Nikodem C, et al. Misoprostol for treating post partum hemorrhage: a randomized controlled trial [ISRCTN72263357]. BMC Pregnancy childbirth. 2004;4:16.PubMedCrossRefGoogle Scholar
  4. 4.
    Prendiville WJ, Elbourne D, Mc Donald S. Active versus expectant management in third stage of labour. Cochrane Database system Rev. 2000;(3):CD000007.Google Scholar
  5. 5.
    Patel A, Goudar SS, Geller SE, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynecol Obstet. 2006;95(3):312.CrossRefGoogle Scholar
  6. 6.
    Bamigboyee AA, Merell DA, Hofmeyr GI, et al. Rectal misoprostol in the prevention of postpartum hemorrhage: a placebo-controlled trial. Acta Obstet Gynecol Scand. 1998;77:178.CrossRefGoogle Scholar
  7. 7.
    Ng PS, Chan AS, Sin WK, et al. A multicentre randomized controlled trial of oral misoprostol and intramuscular syntometrine in the management of third stage of labour. Human Reprod. 2001;16(1):31–5.CrossRefGoogle Scholar
  8. 8.
    Rao SB, Fonseca M, Ajmera S, et al. Is oral misoprostol a promising alternative to standard oxytocics in third stage of labour? Bombay Hosp J. 2002;44(1):30–5.Google Scholar
  9. 9.
    El-Refacy H, O’Brein P, Wale M, et al. Misoprostol in third stage of labour. Br J Obstet Gynecol. 1997;104:336–9.CrossRefGoogle Scholar
  10. 10.
    Mac Donald SJ, Abbott JM, Higgins SP. Prophylactic ergometrine-oxytocin versus oxytocin for third stage of labour. Cochrane database of systematic reviews 2007.Google Scholar
  11. 11.
    Parsons SM, Walley RL, Crane JM, et al. Rectal misoprostol versus oxytocin in the management of third stage of labour. J Obstet Gynecol. 2007;29(9):711–8.Google Scholar
  12. 12.
    Lumbiganon P, Villar J, Gilda Piaggio A, et al. Side-effects of oral misoprostol during the first 24 hours after administration in the third stage of labour, BJOG, an international. J Obstet Gynecol. 2002;109:1222–6.Google Scholar

Copyright information

© Federation of Obstetrics and Gynaecological Societies of India (FOGSI) 2011

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyS.S.G Hospital & Medical CollegeBarodaIndia
  2. 2.BarodaIndia

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