Comparison of Sublingual Misoprostol and Intravenous Oxytocin in the Management of Postpartum Hemorrhage After Cesarean Delivery: A Randomized Controlled Trial

Abstract

Background: Postpartumhemorrhage(PPH)isoneof themostimportantcausesof maternalmorbidityandmortality. Ithasbeen accepted that an effective way for preventing PPH is active management of third stage of labor. Objectives: Thisstudyaimedatfindingtheeffectof 800 µ gofsublingualmisoprostolcomparedto60unitsofintravenousoxytocin in Ringer-lactate to reduce PPH after cesarean delivery. Methods: This single blind randomized clinical trial was conducted at Amir Al-Momenin hospital in Semnan, Iran, from June 2013 to April 2014. A total of 100 pregnant (Gravidity 1, 2) women entered the study. They were randomized into 2 groups. One group received800 µ gsublingualmisoprostol(n=50)andtheothergroupreceived60IUoxytocinintravenously(n=50)inthecesarean section under spinal anesthesia, immediately after the opening of the peritoneum. Results: The mean ± SD decline in hematocrit level after 24 hours of delivery was 2.6% ± 2.3% in misoprostol group and it was 3.2% ± 2.5% in oxytocin group, and the difference was not significant (P = 0.27). The need for the additional uterotonic drug was significantly higher in the oxytocin group (16%) than in the misoprostol group (2.1%) one hour after delivery (P = 0.031). During one hour after delivery, the incidence of shivering was significantly lower in oxytocin group (P = 0.001), but on the contrary, the incidence of hypotension in the oxytocin received patients was higher (P = 0.003). Conclusions: The effectiveness of sublingual misoprostol is similar to intravenous oxytocin in reducing cesarean section hemorrhage. Moreover,becauseshiveringasanuntreatableadverseeffectof misoprostolwasverybothersomeforthepatients,werecom-mend that sublingual misoprostol not be used in high dosage.