A comparative study of efficacy of rectal misoprostol with intravenous methyl ergometrine and intramuscular PGF2a in active management of third stage of labor

Abstract

PPH is almost entirely a preventable condition when management is based on scientifically proven methods. It occurs in approximately 4% of vaginal deliveries, and estimates are that it causes significant morbidity and 25% of all the maternal child birth related deaths. We conducted this study with the following aims to compare the effectiveness of rectal misoprostol (600mcg) with intravenous methylergometrine (0.2mg) and intramuscular PGF2α (125mcg). To find out the percentage of pregnant women having postpartum hemorrhage, amount of blood loss and efficacy and safety of uterotonic drugs during third stage of labor. Patients with full-term singleton pregnancy in the age group of 20-35 years admitted in the maternity ward for vaginal delivery were enrolled in the study after taking written informed consent. The third stage of labor was actively managed in these patients by either 600mcg of misoprostol per rectally (Group A) or 0.2mg of IV methylergometrine (Group B) or 125mcg of PGF2α intramuscularly (Group C) and some were given any prophylactic oxytocic (Group D). Majority 110 (55%) of the studies participants were in the age group of 20-24 years. Moreover, 109 (54.5%) belonged to upper middle (II) socioeconomic class as per modified Kuppuswamy’s socioeconomic scale update for 2018. Only, 7 (3.5%) of the participants were grand multipara’s while 24 (12%) had gestational age greater than 40 weeks. Mean maternal age, gestational age and duration of third stage of labor was comparable in all the study groups. Maximum amount of blood loss was seen among participants who were in control group (201.80 ± 122.81 ml) and the maximum ‘mean difference in Hb’ was also seen in control group (0.83 gm%). Reported side effects during the study included diarrhea, nausea, shivering and vomiting in (1.5%) participants. Postpartum hemorrhage and retained placenta was reported among 7 (3.5%) and 2 (1%) participants only.Misoprostol can be used as a safe and effective alternative agent in active management of third stage of labor.