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

Abstract

Background: Postpartum hemorrhage (PPH) is one of the most important causes of maternal morbidity and mortality. It has been accepted that an effective way for preventing PPH is active management of third stage of labor. Objectives: This study aimed at finding the effect of 800 µg of sublingual misoprostol compared to 60 units of intravenous oxytocin 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 received 800 µg sublingual misoprostol (n = 50) and the other group received 60 IU oxytocin intravenously (n = 50) in the cesarean 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, because shivering as an untreatable adverse effect of misoprostol was very bothersome for the patients, we recommend that sublingual misoprostol not be used in high dosage.