A Randomized Controlled Trial on Prevention of Postpartum Haemorrhage with Sublingual Misoprostol or Oxytocin

Abstract

Introduction: Failure of the uterus to contract adequately after child birth (a tonicity) is the most common cause of 
postpartum hemorrhage and misoprostol produces a rapid peak concentration, and is more effective than oral 
administration. 
Objective: We compared the postpartum blood loss with 400µg sublingual misoprostol and after standard care 
using 10 iu intramuscular oxytocin. 
Study Design: Randomized controlled trial. 
Place and Duration of Study: This study was conducted in a Department of Obstetrics and Gynecology Ghulam 
Muhammad Mahar Medical College Teaching Hospital Khairpur Sindh during 2011. 
Materials and Methods: 60 women for each group were assigned to receive the study medications with in 1 minute 
of clamping and cutting the cord. Chi-square and studentt-test were used to test categorical and continuous 
outcomes. Mean postpartum blood loss and PPH (>500ml), >10% pre- to postpartum decline in hemoglobin and 
reported side effects. 
Results: The mean estimated blood loss with sublingual misoprostol was 200± 125ml (n=60) and 360±136ml with 
oxytocin (n=60) P-value ≤ 0.001.The incidence of PPH was 3.3% with misoprostol and 6.6% with oxytocin group. 
No women lost >1000 ml of blood. Hemoglobin decline of > 10% observed that 11.6% and 45.0% in women after 
receiving misoprostol and oxytocin (P≤ 0.001). Side effects were significantly greater in the misoprostol group than 
in the oxytocin group. 
Conclusion: In this trial we found sublingual misoprostol more effective than intramuscular oxytocinin reducing 
PPH, with only transient side effects.