The Comparison of Misoprostol and Oxytocin Efficacy in the Prevention of Postpartum Hemorrhage Related To Uterine Atony

Abstract

OBJECTIVE: To compare the efficacy of misoprostol and oxytocin in the prevention of early postpartum hemorrhage related to uterine atony. STUDY DESIGN: Ninenty-nine women with normal pregnancy in active phase of labor were enrolled in to this study between January 1999 and May 1999. Pregnancy malpresentation, multiple gestations, toxemia of pregnancy and placental abnormality were excluded. Patients were divided into two groups. In the group 1, only one dose of 600 μg misoprostol (Cytotec® 200 μg tb, Ali Raif) was administered by oral route at the end of second phase of the labor in 50 cases. In the group 2, 20 IU oxytocin in 1000 cc 0.9 % NaCl and was administered as intravenous infusion at a dose of 10 cc/min for the first five minutes and continued at a dose of 2 cc/min. Cases were followed up for duration of third phase of labor, early postpartum hemorrhage (≥500 cc), antepartum and postpartum values of hemoglobin and hematocrit, and adverse effects swoh as nausea, vomiting, diarrhea and trembling. The weight of all neonates was recorded. RESULTS: There was no statistically significant difference between two groups in terms of maternal age, weight, gravida antepartum and postpartum levels of hemoglobin and hematocrit, body temperature, gestational age and neonatal weight. The mean duration of third phase of labor in group 1 and in group 2 were 7.32±3.77 min (1-15 min) and 20.85±4.46 min (12-36 min), respectively. Statistically significant difference was detected between the two groups (p<0.05). The mean decrease of hemoglobin level at postpartum period with respect to antepartum level in group 1 and group 2 was 0.3 g/dL and 0.50 g/dL, respectively, and there was no statistically significant difference between two groups (p>0.05). The rate of early postpartum hemorrhage was 4 % (n=2) in group 1 and 14.29 % (n=7) in group 2, and statistically significant difference was detected between the two groups (p<0.05). The occurrence of trembling in group 1 and group 2 was 82 % (n=41) and 20.4 % (n=1), respectively, and statistically significant difference was detected between the two groups. Mean body temperature at the postpartum first hour were 37.10±0.11°C (36.60-37.60°C) in group 1 and 36.60±0.86°C (35.50-36.80°C) in group 2, and there was statistically significant difference between the two groups (p<0.05). CONCLUSION: We concluded that misoprostolis more effective in the prevention of early postpartum hemorrhage, in decreasing blood loss, and in shorthening the third phase of labor. Although, misoprostol has some transient and unimportant side effects, it can be used as an alternative to oxytocin.