Abstract: Introduction: Postpartum haemorrhage is the most serious complication in obstetric practice. The greatest number of maternal deaths from haemorrhage is due to PPH, which is almost entirely a preventable condition. WHO defines PPH as blood loss of 500 ml or more in first 24 hours post-partum. PPH is one of the most common obstetric maternal complications and is among the three most common etiologies of maternal death worldwide.
Objective: To compare misoprostol versus oxytocin in reducing postpartum hemorrhage after labor induction.
Methods: The study was a randomized clinical trial carried out at the Department of Gynaecology & Obstetrics, Institute Of Child And Mother Health, Matuail, and Dhaka, Bangladesh June 2021 to July 2022. One hundred (110) patients were included. Women with term pregnancy were randomized to receive either 200 µg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life-threatening hemorrhage.
Results: Total 110 women with term pregnancy in two groups of 55 each were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58±244.12 vs. 253.27±171.74 ml; (P= 0.11). The mean duration of third stage of labor was similar and the difference was not statistically significant (6.65±3.47 vs. 6.08±3.07 minutes) (P=0.38), as well as need for additional oxytocics (14.5% vs. 7.2% P=0.18) misoprostol and oxytocin, respectively. In misoprostol group, side effects were shivering, fever, nausea and abdominal pains, while the oxytocin group abdominal pains, headaches and shivering.
Conclusion: Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in the active management of third stage of labor. This study also revealed that a 200 µg tablet may be as effective as the previously investigated higher doses. Thus, misoprostol at 200 µg with its thermo stability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor.
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