Comparison between oxytocin, ergometrine and misoprostol in active management of the third stage of labour: a randomized controlled trial

Authors

  • Abubaker Y. H. Abdel Rahim Department of Obstetrics and Gynecology, MOH, Sudan
  • Mohamed A. A. Gadir E. Ounsa Department of Obstetrics and Gynecology, The National Ribat University, Sudan
  • Rayan G. Albarakati Department of Obstetrics and Gynecology, Majmaah University, Saudi Arabia
  • Elsadig Y. Mohamed Department of Community Medicine, College of Medicine, Majmaah University, Saudi Arabia
  • Sawsan M. Abdalla Department of Community Medicine, College of Medicine, Majmaah University, Saudi Arabia

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20182313

Keywords:

Ergometrine and misoprostol, Oxytocin, Third stage of labor

Abstract

Background: The aim of the present study was to compare the effectiveness of sublingual misoprostol, intravenous infusion of oxytocin, and intravenous infusion of Ergometrine in reducing blood loss during the third stage of labor.

Methods: This is a no-random trial study conducted in in Ribat University Hospital, Khartoum among 150 laboring ladies with a healthy singleton pregnancy. After obtaining their written informed consent to participate in the study, they were randomly assigned to one of three possible treatment groups: 400 μg of sublingual misoprostol; 10 IU of intravenous infusion oxytocin; and 0.5 mg of intravenous infusion of Ergometrine. Blood loss was estimated by weighing the collected blood and converting the weight to milliliters.

Results: The shortest mean duration of the third stage of labor was seen in patients who received misoprostol (3.89±0.37 min), followed by oxytocin (4.6±0.9 min), and Ergometrine (5.45±0.9 min). The lowest mean blood loss was seen in the patients who received 400 µg misoprostol (168.36±24.83 ml), followed by those who received 10 IU oxytocin (205.56±34.82 ml), and 0.5 mg Ergometrine (214.49±35.97 ml).

Conclusions: Present study showed that 400 µg sublingual misoprostol was more effective than the conventional parenteral uterotonics in reducing the amount of the blood loss during the third stage of labor and has comparable effect to that of 10 IU intravenous oxytocin in shortening the duration of third stage of labor. It also showed that the use of misoprostol reduces the need for extra-uterotonics and blood transfusion.

References

Abou Zahr C. Antepartum and postpartum hemorrhage. In Maurray CJL, Lopez AD, eds. Health Dimensions of Sex and Reproduction. Boston: Harvard University Press;1998:172-181.

Poggi BH. Postpartum hemorrhage and the abnormal puerperium. In DeCherney AH, Nathan L, Goodwin TM, Laufer N, eds. Current diagnosis and treatment. Tenth edition. USA: McGraw-Hill;2007:477-97.

B-Lynch C, Keith LG, Lalonde AB, Karoshi M, eds. Postpartum Hemorrhage. A comprehensive guide to evaluation, management and surgical intervention. UK: Sapiens Publishing;2006:2-44.

Mohammed AA, Mohammed E, Elnour M, Ahmed S, Abdelfattah A, Ahmed F. Maternal mortality community-based survey in Kassala state-Estern Sudan. Int Gynaecol Obstet. 2009;107S2:S271.

Mohammed AA. Postpartum hemorrhage, hospital experience in high maternal mortality zone in Sudan. Int Gynaecol Obstet. 2009;107S2:S271.

Gohilcorresponding JT, Tripathi B. A Study to compare the efficacy of misoprostol, oxytocin, methyl-ergometrine and ergometrine–oxytocin in reducing blood loss in active management of 3rd stage of labor. J Obstet Gynaecol India. 2011 Aug; 61(4):408-12.

Prendiville WJ, Elbourne D, McDonald S. Active vs. expectant management in the third stage of labour. Cochrane Database Systemat Rev. 2004;2:CD000007

Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Acive versus expectant management of third stage of labour: the Hinchingbrooke randomized controlled trial. Lancet. 1998;351:693-99

Singh G; Radhakrishnan G; Guleria K. Comparison of Sublingual Misoprostol, Intravenous Oxytocin, and Intravenous Methylergometrine in Active Management of the Third Stage of Labor. Obstet Anesthes Digest. 2011; 31(1):33.

Freise KJ, Widness JA, Veng-Pedersen P. Erythropoietic response to endogenous erythropoietin in premature very low birth weight infants. Pharmacol Experiment Therapeut. 2010;332:229-37.

Seli E, Agarwal A, eds. Fertility preservation. New York: Springer, 2012:226. Available at http://www.springer.com/la/book/9781441917829 Accessed on 1.10.2017.

Singh G, Radhakrishnan G, Guleria K. Comparison of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labour. Int Gynaecol Obstet. 2009;107:130-4.

Davies G, Tessier J, Woodman M, Lipson A, Hahn P. Maternal hemodynamics after oxytocin bolus compared with infusion in the third stage of labor. Obstet Gynecol. 2005;105:294-9.

Sultana N, Khatun M. Misoprostol versus oxytocin in the active management of the third stage of labour. Bangladesh Coll Physic Surg. 2007;25:73-76

Chong YS, Chua S, Shen L, Arulkumaran S. Does the route of administration of misoprostol make a difference? Euro Obstet Gynecol Reprod Biol. 2004;113:191-8.

Orji E, Agwu F, Loto O, Olaleye O. A randomized comparative study of prophylactic oxytocin versus Ergometrine in the third stage of labor. Int Gynaecol Obstet. 2008;101:129-32.

Downloads

Published

2018-05-26

Issue

Section

Original Research Articles