Published: 2017-04-27

A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

Anjuman Alam, Paresh Shyam, Swapnil Goswami


Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).

Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.

Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.

Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility.


Active management of third stage of labour, Postpartum haemorrhage, Uterotonics

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Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmil A, et al, Global, Regional and national level and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. 2016;387(10017): 462-74.

UN inter-agency estimates. Maternal Mortality, Unicef Data; 2015.

John RS, Ronald MR, Postpartum haemorrhage. Maternal mortality. Fact sheet; 2016.

Registrar General of India’s Sample Registration System (RGI- SRS; the sole source of data for fertility and mortality in India); 2011-13.

World Health Organization. Recommendations for the Prevention of Postpartum Haemorrhage. Geneva: WHO; 2007.

Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM, The Bristol Third Stage Trial: active versus physiological management of third stage of labour. BMJ. 1988;297(6659):1295-300.

Rogers J. Active versus expectant management of third stage of labour. 1988:351(9104):693-9.

Prendiville WJ. Active versus expectant management in the third stage of labour. Cochrane Database Sys Rev. 2000(3):CD000007.

Elbourne DR. Active vs. conservative third stage management: Cochrane database of systemic review. 1994;5352.

Abalos E. Choice of uterotonic agents in the active management of the third stage of labour. RHL Commentary. The WHO Reproductive Health Library; Geneva: World Health Organization revised; 2009).

Cotter AM, Ness A, Tolosa JE. Prophylactic oxytocin for the third stage of labor Cochrane. Prophylactic oxytocin for the third stage of labour. Cochrane Database Sys Rev. 2001, 4. CD001808.

McDonald S, Abbott JM, Higgins SP. Prophylactic ergometrine–oxytocin versus oxytocin for the third stage of labour. Cochrane Database Syst Rev. 2004;(1):CD000201.

Khan GQ, John IS, Wani S, Doherty T, Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of placenta: a randomized controlled trial. Am J Obstet Gynecol 1997;177(4):770-4.

Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ. Prostaglandins for preventing postpartum haemorrhage Cochrane. Database of Sys Rev. 2007;3CD000494.

Hofmeyr GJ, Walraven G, Gülmezoglu AM, Maholwana B, Alfirevic Z, Villar J. Misoprostol to treat postpartum haemorrhage: a systematic review. BJOG. 2005;112:547-53.

Villar J, Gülmezoglu AM, Hofmeyr GJ, Forna F. Systematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage. Obstet Gynecol. 2002;100:1301-12.

Liabsuet T, Choobun T, Peeyananjarassri K. Prophylactic use of ergot alkaloids in the third stage of labour. Cochrane Database Syst Rev. 2007;2:CD005456.

Joy SD, Sanchez-Ramos L, Kaunitz AM. Misoprostol use during the third stage of labor. Int J Gynaecol Obstet. 2003;82:143-52.

Gülmezoglu AM, Villar J, Ngoc NT, Piaggio G, Carroli G, Adetoro L, et al. WHO multicentre double-blind randomized controlled trial to evaluate the use of misoprostol in the management of the third stage of labour. 2001;358:689-95.

Tuncalp O, Hofmeyr GJ, Gulmezoglu AM: Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012;8:CD000494,

Mobeen N, Durocher J, Zubery N. Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirth in Pakistan: a randomised placebo-controlled trial. BJOG. 2011;118(3):353.

World Health Organization: WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, World Health Organization; 2012:4.

Gohil JT and Tripathi B, ‘A Study to Compare the Efficacy of Misoprostol, Oxytocin, Methyl-Ergometrine and Ergometrine-Oxytocin in Reducing Blood Loss in Active Management of third Stage of Labor. J Obstet Gynaecol India. 2011;61(4):408-12.

Singh, Gunjan; Radhakrishnan, Gita; Guleria, Kiran, Comparison of Sublingual Misoprostol, Intravenous Oxytocin, and Intravenous Methylergometrine in Active Management of the Third Stage of Labor. IJGO, India. 2010;13:42-6.

Sharma M, Kaur P, Kaur K, Kaur A, Kaur PK, Kaur MM. A comparative study of oxytocin/misoprostol/methylergometrine for active management of the third stage of labor. J Obstet Gynecol India. 2014;64(3):175-9.