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Journal of Bangladesh College of Physicians and SurgeonsVol. 25, No. 2, May 2007
Misoprostol Versus Oxytocin in the Active Management
of the Third Stage of Labour
oxytocin (P>0.50). Measured blood loss of more than 1000
ml occured 2.38% of the misoprostol group compared with
Objective : A randomised controlled trial was performed in
1.58% in the oxytocin group (P>0.50). There was no
Sir Solimullah Medical College Mitford Hospital, a tertiary
significant difference in the need for additional oxytocin
hospital in Dhaka City for one year to compare oral
drugs or blood transfusion in women of both groups.
misoprostol with intramascular oxytocin in the prevention
Significant side effect of misoprostol were shivering
of post partum haemorrhage (PPH). Method: A total of 400
(P<0.01). Conclusion : Oral misoprostol is as effective as
women were randomised to received either 400mg
intramascular oxytocin in the prevention of PPH.
misoprostol orally or 10 I.U oxytocin intramascularly. The
Shivering and transient pyrexia were special side effects of
incidence of post partum haemorrhage and side effects
misoprostol. Misoprostol has potential in reducing the high
were examined. Result: The demographic and labour
incidence of PPH in developing countries.
characteristic were comparable. PPH occured in 3.80% of
women given misoprostol and in 2.63% of those given
(J Bangladesh Coll Phys Surg 2007; 25 : 73-76)
also very useful for cervical ripening and induction of
Post partum haemorrhage (PPH) is a serious
labour. 6,7 It is also used in 1st and 2nd trimester
obstetrics problem and primary PPH is said to occur
abortion and has been shown in several randomised
in about 5-8% of deliveries.1 Maternal mortality in
placebo controlled trial to significantly reduce risk of
Bangladesh is about 3 per 1000 live birth.2 Among
PPH and also control of PPH.6 It is stable at room
the other causes haemorrhage ranging 20-25% of
temperature, low cost, easily administrable, available
cause of maternal mortality and 12% due to
in tablet form and definitely advantageous than the
other PGs with few systemic side effect. Its
haemorrhage. PPH is one of the leading cause of
absorption is rapid and effect on the post partum
maternal mortality in developing country. 3,4 The
common cause of PPH is uterine atony (80%).1 The
Our aim was to show the effectivity of oral
underlying principle in active management is to
misoprostol versus oxytocin for the active
excite powerful uterine contraction following birth of
management of third stage of labour to reduce the risk
the head or anterior shoulder of the baby, which
minimise the blood loss in third stage approximatelyto 1/
Materials and Methods :
5th.3 Prostaglandin are hormone naturally present
This is a prospective longitudinal study was
in the uterus that causes contraction during labour.5
conducted in the Gynae department of Sir Solimullah
Misoprostol is a synthetic 15-doxy 16 hydroxy-16
Medical College Mitford Hospital during the period
methyl analogue of naturally occurring prostaglandin
of January 2003 to December 2003. A total of 400
E1 (PGE1). Because of its prostagladin activity it is
(Four) hundred parturient women were randomised toreceived either 400 microgram (μg) of misoprostol
Dr. Nilufar Sultana, MBBS, FCPS (Gynae), Assistant Prof.
orally or 10 I.U oxytocin intramascularly just after
(Gynaecology), Begum Khaleda Zia Medical College, Dhaka.
cord clamping labouring women either nulliparous or
Prof. Mahmuda Khatun, MBBS, FCPS (Gynae), Professor &
multiparous with no known risk for excessive third
Head of the Dept. of Gynae & obst., SSMC & Mitford
stage blood loss, vertex presentation, no previous
caesarean section delivery, induced, augmented or
Address of Correspondence:
Dr. Nilufar Sultana, MBBS, FCPS
spontaneous labour were included. Among the 400
Assistant Prof. (Gynaecology), Begum Khaleda Zia MedicalCollege, Dhaka.
patients, 210 patients were selected for misoprostol
6 December, 2004
10 November, 2006
and 190 were selected for intramascular oxytocin.
Journal of Bangladesh College of Physicians and Surgeons
Outcome measures were incidence of post partum
haemorrhage, estimation of average blood loss. the
Among the 400 patients, 210 were assigned to receive
length of the third stage of labour, the percentage of
misoprostol and 190 received oxytocin randomely. At
women requiring manual removal of Placenta, further
randomization the two group were well balanced
oxytocin and blood transfusion and the side effect of
and comparable for demographic and labour
both the groups. Blood loss was estimated on
approximate basis by the delivering physician after
In misoprostol group significant number of patient
developed shivering, which was statistically
Statistical analysis was performed using SPSS
significant than the oxytocin group. Other parameters
Programme. Data were analysed by chi-square test (x
of both groups showed no significant difference.
to compare frequency distribution. A difference was
The result of both groups are shown in the following
considered statistically significant at p value 0.05 level.
tables. n=total number of patient. no=number.
Post partum haemorrhage due to uterine atonicity.
x2= 0.4409 df. 1, P>0.50In table 1, 8 patient in misoprostol group and 5 patient in oxytocin group develop PPH, which is not significant statistically.
Table II shows average blood loss in each patient in both group 325.4 ml and 375 respectively which is notsignificant statistically.
Measured blood loss > 1000 ml occurred
x2= 0.328, P>0.50In this table; more than 1000 ml blood was lost in 5 & 3 patients in misoprostol & oxytocin group respectivelywhich is not significant.
Additional Oxytocin drugs require before and after separation of placenta.
x2= 0.1978, P>0.50Additional oxytocin required for further uterine contraction in 5 and 6 patients respectively in two group whichis not significant statistically.
Misoprostol Versus Oxytocin in the Active Management of the Third Stage of Labour
Time required for the separation of placenta in each patient of both group is not statistically significant.
Patient required manual removal of placenta
x2= 0.2456, df 1, P>0.50Manual removal of placenta require only 2 patients in misoprostol & I in oxytocin group respectively which isstatistically not significant.
Pain during third stage of Labour
x2= 0.1978, P>0.50Here only 5 and 4 patients developed pain respectively in both group which is also not statistically significant.
Character Misoprostol (n=210) Oxytocin (n=190)
x2= 7.296, df 1, P<0.01 (Significant) x2= 7.488, df 1, P<0.50 ( not significant) This table shows, 13 patients in misoprostol group 2 patient in oxytocin group developed shevering after use ofdrugs. This is statistically significant. Diarrhoea & fever develop about 4 & 2 patient respectively in both groupwhich is not statistically significant
Journal of Bangladesh College of Physicians and Surgeons
Misoprostol, is a synthetic PGE1. analogue. Its FDA
Oral misoprostol is as effective as intramascular
approved indication is for the prevention of stomach
oxytocin in the prevention of PPH. So, oral
ulcer in patient taking non steroidal anti-inflamatory
misoprpstol can replace intramascular oxytocin in the
drugs. Because of its prostaglandin activity it is also
active managment of third stage of labour in low risk
used for reducing the risk of PPH and also to control
women in developing countries especially as it is
of PPH.6,7 It is available in tablet form and can be
administered orally and it is thermostable in tropical
given orally and rectally for the active management ofthird stage of labour. In this study, we gave 400
conditions. Shivering and transient pyrexia were
microgram (μgm) of misoprostol orally in one group
specific side effects of misoprostol which has
(n=210) and intramascular oxytocin 10 I.U. in another
potential in reducing the high incidence of PPH in
group (n=190). The incidence of PPH in misoprostol
group and oxytocin group were 3.80% versus (vs)
2.63% which is comparable to another study e.g. 1%
K Begum, TIMA. Faruq, N. Sultana. Management of severe
us 0% respectively done by OboroVO, Tobowei TO.9
primary post partum Haemorrhage: A New but simple
The estimated average blood loss in each patient of
suturing techinque. Journal of Bangladesh college of
this study was 325.4 ml in misoprostol group and 375
physician and surgeons, 2002 May; 20 (2): 49-53.
ml in Oxytocin group respectively which coincide
Bangladesh Bureau of Statistics, 1999 Nov. P-37
with 345 ml vs 417 ml in another study done by
D.C. Dutta, Safe Motherhood, obstetric care and the
Surbek DV et al.10 The length of third stage labour in
Society, epidimiology of obstetrices, chapter-37: Fifth
each patient in present study was 4 minute 49 sec in
misoprostol group and 5 minute in oxytocin group
Abu Jamil Faisel, Brian Mc. Carthy, Jeanna Mc. Dermott
which is less than another study e.g 8 minute vs 9
Hani Atrash, Michael Lane- Post partum infection and
minute but similar regarding statistical significance
haemorrhage in Rural Bangladesh, J. of Bang. Fertility
because both studies shows no significant difference
between two group.10 Blood loss more than 1000ml in
Alfirevic Z. Oral misoprostol for induction of labour.
present study was 2.38% vs 1.58% which is
Cochranc Review Abstracts 2002. up dated 04/01/2002.
comparable to another study e.g. 3.7% vs 2% done by
S Nahar. Rectal use of Misoprostol in controlling post
kundodyiwa Tw et al. 11 The additional oxytocin
partum haemorrhage (PPH) Journal of Bangladesh College
before or after placental separation was used less often
of Physician and Surgeons: 2003 Jan, 21 (1): 10-13.
in both groups such as 2.38% vs 2.63% which is
Myer S. Bornstein, M.D and Don Shuwarger, M.D:
comparable to another study 16% vs 38% e.g. both
Protocol: Misoprostol (Cytotec) for cervical Ripening and
study shows no statistically significant difference.10
induction of Labour obgyn. net/english/06/misoprostal
Regarding blood transfusion, it was 1.90% vs. 1.58%
respectively in this study which is comparable to
Karim A. Antiulcer PG misoprostol. single and mutiple dose
study done by kundodyiwa Tw et al.11 The manual
pharmaco-kinetic profile. Prostaglandines : 1987:33 (Suppl)
removal of placenta required 0.95% vs 0.53%
respectively in this study which is also similar to one
Obore VO. Tabowei TO. A randomised controlled tiral of
study.10 There were no significant difference in pain
misoprostol Versus oxytocin in the active management of
during third stage of labour, post partum fever or
the third stage of labour. J obstel Gynaecol 2003 Jan: 23 (1):
diarrhoea but shivering was more in the misoprostol
group which was observed in present study and all
Surbek DV. Fehr PH, Hosli I, Holzgreve W. Oral
other studies which is statistically more significant
Misporostol for third stage of labour: a randomized placebo-
than the oxytocin group. 9,10,11 From above discussion
controlled trial. Obstel Gynaecol 1999 Aug; 94 (2): 255-8
it has been observed that in all the parameter except
Kundodyiwa TW, Majoko F, Rusakawni Kos. Misoprostol
shivering there were no significant difference between
Versus oxytocin in the third stage of labour, Int. J Gyanaecol
the misoprostol group and oxytocin group.
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