Randomized Controlled Trial of Rectal Misoprostol Versus Oxytocin in Third Stage Management

Objective: To compare rectal misoprostol with oxytocin for routine management of the third stage of labour.Study design: A total of 240 parturient women were randomized, at three University of Toronto teaching hospitals, to receive either rectal misoprostol (400 µg) after delivery of the infant or parenteral oxytocin (5 units IV or 10 units IM) with the delivery of the anterior shoulder, when possible, or 5 units IV or IM after the delivery of the placenta.The primary outcome measure was change in hemoglobin (ΔHgb]) from admission in early labour to day one postpartum.Setting: The labour ward of three University of Toronto teaching hospitals: St. Michaels, Toronto General, and Mount Sinai.Population: Labouring women either nulliparous or muciparous with no known risk for excessive third stage blood loss; vertex presentation; no previous Caesarean delivery; induced, spontaneous, or augmented labour.Results: No difference in ΔHgb] was observed between the two groups; the ΔHgb] in the oxytocin and misoprostol groups were 1.43 g/L (95% confidence interval Cl], 1.2–1.6 g/L) and 1.59 g/L (95% Cl, 1.4–1.8 g/L) respectively (p = 0.35). Secondary outcome measures (excessive third stage bleeding, duration of third stage of labour, need for manual removal of the placenta or the need for additional oxytocics) did not differ between the two groups.Conclusion: Rectal misoprostol is of equivalent efficacy to parenteral oxytocin for the prevention of primary postpartum hemorrhage. Rectal misoprostol is an appropriate uterotonic agent for routine management of the third stage of labour.