Abstract
Background: The use of uterotonic agents in active management of the third stage of labor has been shown to reduce postpartum hemorrhage. Although intramuscular oxytocin remains the uterotonic of choice, others such as intravenous oxytocin, ergometrine, carboprost, and misoprostol can be used. Sublingual misoprostol has been shown to have the greatest bioavailability, achieving the highest plasma concentration in the shortest time when compared to other routes at equal dose.
Objective: To evaluate whether the addition of sublingual misoprostol to intramuscular oxytocin in active management of the third stage of labor is beneficial.
Methodology: This was a randomized controlled trial that involved all women planned for vaginal delivery who presented in labor. After consenting, these women were randomly assigned and received either 600µg of sublingual misoprostol and 10IU of intramuscular oxytocin or 10IU of intramuscular oxytocin alone. Following delivery of the placenta, blood loss was assessed by the gravimetric method. The data obtained was analyzed and compared between the two groups.
Results: Three hundred and six women were randomized in this study, one hundred and fifty-three women into each group. Baseline characteristics and risk factors for postpartum hemorrhage were similar for both groups except for parity, maternal weight, and cervical laceration. When these were subjected to logistic regression, they were not found to significantly predict the occurrence of postpartum hemorrhage.
Sublingual misoprostol in addition to IM oxytocin significantly reduced postpartum hemorrhage, duration of the third stage, blood transfusion, and need for additional uterotonics as compared to IM oxytocin alone. Fever and shivering occurred more in the misoprostol group, but only shivering was statistically significant. All side effects were transient and self-limiting.
Conclusion: The addition of sublingual misoprostol to IM oxytocin has statistical significance in reducing primary postpartum hemorrhage, duration of the third stage of labor, blood transfusion, and need for additional oxytocics.
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Corresponding Author
Dr Bernard. O. Ewuoso
DOI: https://dx.doi.org/10.18535/jmscr/v12i11.01
