randomized controlled trial of oral misoprostol for the third stage of labor

ABSTRACT

To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g. followed by two doses of oral misoprostol 100 micro g 4 hours apart Group 2 received oral misoprostol 404 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 lU; and group 4 received intravenous infusion of oxtytocin 10 lU plus intramuscular administration of methylergonovine maleate [Methergine] 0.2 ma. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2. compared with 3.2% in group 1 and 3.5% in group 4 [P<.01, and P = .01, respectively]. There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 [5.9%, versus 2.2% P = .01]. The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 [P < .01 and P = .01, respectively]. Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin