Is Combined Lower Dose Misoprostol and Oxytocin More Effective Than Oxytocin Alone in Active Management of Third Stage of Labor? - A Randomized Controlled Trial

Abstract

Background: Despite established evidence that active management of third stage of labour (AMTSL) reduces the frequency of primary postpartum haemorrhage (PPH), it remains a major direct cause of maternal mortality in low-income countries of the world.  This study was to compare the efficacy of combined low-dose sublingual misoprostol and oxytocin, with standard oxytocin alone in the AMTSL.

Methods: Randomization of 180 parturients to receive either 200mcg misoprostol sublingually plus 10 IU intramuscular oxytocin as group A or 10 IU intramuscular oxytocin alone as group B. The mean blood loss, incidence of PPH, need for additional uterotonic, duration of third stage of labour, post-delivery pulse rate (PR), need for blood transfusion and side effects of the drugs were analyzed using chi-square and t-test.

Results: A total of 180 parturients equally divided into groups A and B. The mean blood loss in group A was 213.44 ± 191.17mls compared to 292.11 ± 242.80mls in group B with a p-value of 0.017. The incidence of PPH in Group A and Group B were 9% versus 13% respectively, p-value = 0.343. The differences in other outcomes measured between both groups were not statistically significant except the need for additional oxytocic which was more in group B.

Conclusion: The addition of lower dose misoprostol to the standard intramuscular dose of oxytocin in AMTSL significantly reduced the mean blood loss as well as the need for additional oxytotic though no significant difference in the incidence of PPH.

Key words: PPH, AMTSL, misoprostol, Oxytocin and Blood loss.