Comparative study between the use of rectal misoproostol versus intravenous syntometrine in the active management of the third stage of labour

Postpartum hemorrhage is one of the major maternal killers. The use of uterotonics reduces the occurance of atonic postpartum hemorrhage. Oral Misoprostol [prostaglandin E1 analogue] used for the prevention of peptic ulcer disease was reported to prevent postpartum hemorrhage The present study is to compare between the effectiveness and side effects of rectally administered PG E1 analogue [misoprostol] and IV Syntometrine [0.5 mg a methyl ergometrine plus 5 IU of syntocinon] for prevention of atonic postpartum hemorrhage minimizing blood loss during the early postpartum period. Prospective randomized study. Three hundred cases who attended in El-Shatby Maternity Hospital, Obstetrics and Gynecology Department, Alexandria University were included in the study. All patients had a fuliterm living single fetus, presenting by the vertex, with a smooth course of the 1st and 2nd stages of labour. Cases were categorized into 3 groups: Group A [100 cases]: received Syntometrine in intravenous infusion of 500 ml saline immediately after delivery of the baby. Group B [100 cases]: received 2 tablets of Mesotec [total of 400 ug] rectally immediately after delivery of the baby. Group C [100 cases]: received IV infusion of 500 ml saline without any medications and placebo tablets rectally immediately after delivery of the baby. The amount of blood lost was evaluated by visual estimation, calculation, and lab parameters. Misoprostol with its rapid onset of action was more effective than intravenous infusion of syntometrine and placebo in terms of minimization of the amount of blood loss, shortening the duration of the third stage, in addition to decreasing the rate of postpartum hemorrhage. It is also cheap, more stable, and has less side effects