Comparison of Oral Misoprostol with Conventional Uterotonics in the Management of Third Stage of Labor


background: Randomized prospective control study it is objective to compare effect of oral misoprostol with conventional uterotonics in the management of the third stage of labor.Aim of study: The incidence of Hemorrhage and the decrease in hemoglobin concentration is the main out comes of the trial. Secondary outcomes included the occurrences of sever postpartum hemorrhage.Patient and method: This study was done in Department of obstetrics and gynecology at Baghdad Teaching Hospital. In controlled trials a pregnant women total number 280 were randomized into four groups, as followed: Group I: received oral misoprostol 400 Mg, followed by two doses of oral misoprostol 100 Mg 4hours a part. (n=72), group 2: received intravenous infusion of oxytocin10 IU plus oral misoprostol 400 Mg followed by two doses of 100Mg oral misoprostol 4 hours apart group 3: received intravenous infusion of oxytocin 10 IU. (n=69), group 4: received intravenous infusion of 10 IU oxytocin plus intramuscular administration of methylergometrine (methergine) 0.2 mg. (n=77). The data of 40 women were excluded from the study because of loss to follow up, previous cesarean deliveries performed after randomization n=25, pre delivery hemoglobin was unavailable n= 10, postpartum percentage of hematocrit unavailable n=5. Main measures, the incidences of postpartum hemorrhage and the changes in hematocrit concentration from before delivery to 24 hours postpartum, in those women used oral misoprostol in management of third stage of labor with or without the use of other uterotonicsResult: Shows, Mean blood loss in misoprostol group was not significantly higher than blood loss in oxytocin group and oxytocin misoprostol group, but there was statistically significant difference when compared with oxytocin-methylergometrine group.Conclusion: Oral administrated misoprostol is as effective as conventional oxytocic in prevention of postpartum hemorrhage