Comparison of Intravenous (IV) Oxytocin with (IV) Oxytocin plus Sublingual Misoprostol for Active Management of Third Stage of Labor in Vaginal Birth among Primigravida with Singleton Pregnancy

Abstract

Objective: To compare intravenous (IV) oxytocin with IV oxytocin plus sublingual misoprostol for active management of third stage of labor in vaginal birth among primigravida with singleton pregnancy.

Methodology: This randomized controlled trial study was conducted in MCH Center, Unit I, Pakistan Institute of Medical Sciences, Islamabad after the approval of synopsis from Dec 2017 to  Jun, 2018. A total of 65 patients each were enrolled in each study group. Women presenting to MCH Center at term, who were primigravida, had singleton gestation at term (37 to 41 weeks) and were in spontaneous labor were included in the study. Patients with instrumental vaginal deliveries, AVBD, APH and with any medical disorders including PIH were excluded. Group A received IV oxytocin 10 IU + misoprostol 400 mg sublingually whereas group B patients received IV oxytocin 10 IU. The primary study outcome was measured in terms of comparison of mean blood loss between the study groups.

Results: Overall most of the women were between 26 and 30 years. Average age of patients was 27.4 ± 2.6 years in oxytocin + misoprostol group compared to 27.5 ± 2.2 years in the oxytocin alone group. The frequency of blood loss > 500 ml was 13.8% in oxytocin alone group compared to 4.6% in oxytocin + misoprostol group. The mean blood loss was 363.1 ml in oxytocin + misoprostol compared to 406.9 ml in the oxytocin alone group (p-value, <0.001). In the combination group 4 (6.0%) cases were found to have shivering compared to 1 (1.5%) in oxytocin alone group.

Conclusion: Combination of IV oxytocin + sublingual misoprostol is better than IV oxytocin alone in the management of blood loss in the third stage of labour. The mean blood loss was significantly lower in the combination group when compared with IV oxytocin alone group.