Rectal Misoprostol versus Oxytocin in The management of the third stage of labor

  • Weaam F.ALmahfooth F.I.C.M.S,C.A.B.O.G,D.G.O Department of Gynecology & Obstetrics College of Medicine University of Basrah 2010
  • Edwar Z. Khosho,F.I.C.M.S


Objective: To compare the effectiveness of rectally used misoprostol in the active management of third stage of labor with intramuscular oxytocin. Methods: A comparative prospective study was performed at 2 hospitals in Basrah, 200 pregnant women in active labor were enrolled. Women were randomized to receive rectal misoprostol 600µg or intramuscular oxytocin 10 IU with delivery of the anterior shoulder. The primary outcome measures were the incidence of postpartum hemorrhage or change in Hb. concentration before delivery and 12hour after delivery. Secondary outcomes included the need for additional uterotonic agents, sever post partum hemorrhage ,blood transfusion , and medication side effects. Results:  The percentage of PPH was 5% in the misoprostol group and 6% in oxytocin group (p >0.05). There were no significant difference among the groups in the drop of Hb. conc. (p>0.05). Secondary outcome measures including severe PPH and the duration of the 3rd stage of labor and medication side effects were similar in both groups. Conclusion: Rectal misoprostol 600µg is as effective as 10 IU intramuscular oxytocin in minimizing blood loss in the 3rd stage of labor. This confirms the utility of misoprostol as a safe and effective uterotonic drug for use in some areas where other pharmacologic agent may be less feasible.


-DK James, PJ steer , CP Weiner and B Gonik. Postpartum hemorrhage;

High risk pregnancy.2nd ed. W.B. Saunders, 1999 :1229

-Dombrowski MP, Bottoms SF and Saleh AA , third stage of labor :

analysis of duration and clinical practice. Am. J. Obstetrics Gynecology 1995 ; 172:1279.

-Combs CA , Laros RK Jr , prolonged third stage of labor : morbidity and risk factors,

Obstetrics Gynecology 1991 ; 77 :863

-Stones RW , Paterson CM ,Saunders NJ , Risk factors for major Obstetrics hemorrhage .

Eur J Obstetrics Gynecology Reprod Biol 1993;48:15-18

-Keith Edmonds ,third stage of labor and abnormalities,Dewhurst textbook of obstetrics

and gynecology 6th . ed.London, Black well science LTD,1999 :330-41.

-Dollery C. , ed. Therapeutic Drugs , 2nd ed. Edinburgh , Churchill living stone , 1999 :92-8 .

-Hunter DJ , Schulz P , Wassenaar W. Effect of carbetocin along acting oxytocin analogue

on the post partum uterus. clinical pharmacol.Therapy. 1992;52: 60-7

-D. Keith Edmonds . Induction and augmentation of labor . Dewhurst’s text Book

of Obstetric and Gynecology. 7th ed.London, Black Well 2007 :20

-Yap- Seng Chong , Lin Lin Su , Arulkumaran S. Misoprostol: quarter century of use ,

abuse and creative misuse. Obst. Gynecol. Survey 2004;59:128-40.

-M.Zieman , S. K. Fong , N. L .Benowitz and P. Darney . Absorption Kinetics of misoprostol

with oral or vaginal administration .Obstet. Gynecol. 90 ( 1997 ) :88 - 92

-Kenneth R. McQuaid,MD. Drug used in treatment of gastrointestinal disease.Basic and Clinical pharmacology.10thed.BertramG.Katzung,2007:1018 .

- Abdel –Aleem H ,Villar J , Gulmezoglu AM , et al . the pharmacokienetics of the

prostaglandin E1 analogue misoprostol in plasma and colostrums after post partum

oral administration . Eur. J obstet. Gynecol. Reprod Biol 2003 :108:25-8.

-Khan RU , El –Refaey H. pharmacokinetics and adverse-effect profile of rectally

administered misoprostol in the 3rd stage of labor . Obstet. Gynecol. 2003 :101 :968-71

-Nellore V , Mittal S , Dadhwal V , Rectal misoprostol versus 15-methyl prostaglandin F2

alpha for the preventionof postpartum hemorrhage .Int J of Gynecologyand

Obestetric(2006) 94, 45-46.

-Karkanis SG ,Caloia D , Salenieks M. E , Kingdom J . , Messe F . ,et al . Randomized

controlled trial of rectal misoprostol versus oxytocin in the 3rd stage management .

J Obstet. Gynecology Can.2002; 24:149-54.

-Bugalho A .,Danial A. ,Faundes A. , Cunha M. , Misoprostol for prevention of postpartum

hemorrhage .International J. Gynecol. Obestet. 2001; 73:1-6.

-Parsons S M ,Walley R L , Crane JMC ,et al. Rectal misoprostol versus oxytocin in the

management of 3rd stage of labor . J obstet. Gynecol Can 2007 ;29 :711-18.

-Parsons SM .Walley RI , Grane JMG , Matthews K , Hutchens D. Oral misoprostol versus

oxytocin in management of 3rd stage of labor . J Obstet Gynecol. Can 2006;28:20-6 .