ADJUNCTIVE RECTAL MISOPROSTOL VERSUS OXYTOCIN INFUSION FOR PREVENTION OF POSTPARTUM HAEMORRHAGE IN PATIENTS AT RISK: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: In the management of parturients with risk factors for uterine atony, it is
generally considered good practice to administer an adjunctive uterotonic agent after
routine active management of the third stage of labour.
Objective: Adjunctive rectal misoprostol was compared with oxytocin infusion after
routine active management of the third stage of labour in parturients with risk factors for
PPH, to determine its effectiveness in reducing intrapartum blood loss and postpartum
haematocrit drop, as well as need for additional uterotonics or surgical intervention.
Method: 255 parturients with risk factors for PPH were randomized to receive either
rectal misoprostol (600μg; n=126) or oxytocin infusion (20IU in 500mL; n=129) after
routine active management of the third stage of labour. Intrapartum blood loss was
measured using a combination of the BRASSS-V calibrated drapes and differential pad
weighing. Haematocrit was measured intrapartum and 24hrs postpartum.
Results: There was no significant difference (Sig.=0.986) in the mean intrapartum blood
loss between the misoprostol (387.28 ± 203.09mL) and oxytocin (386.73 ± 298.51mL)
groups. There was also no difference in the requirement for additional uterotonics or
surgical intervention for uterine atony (p = 0.841). The postpartum haematocrit drop was
however less in the misoprostol group (Sig. = 0.000).
Conclusion: Rectal misoprostol is as effective as oxytocin infusion as an adjunct for
prevention of PPH in patients with risk factors for uterine atony and is associated with a
lower haematocrit drop postpartum. However, shivering, pyrexia and vomiting are more
frequent with misoprostol though these are usually self limited.

ADJUNCTIVE RECTAL MISOPROSTOL VERSUS OXYTOCIN INFUSION FOR PREVENTION OF POSTPARTUM HAEMORRHAGE IN PATIENTS AT RISK: A RANDOMIZED CONTROLLED TRIAL