Comparison of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in active management of the third stage of labor

Abstract

Objective: Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of the study is to compare the effect of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in the AMTSL in terms of amount of blood loss and duration of the third stage of labor, cost-effectiveness, and side effect profile. Materials and Methods: Seventy-five pregnant patients admitted in the maternity ward for vaginal delivery from February 2017 to February 2018 received either intramuscular methylergometrine (0.2 mg) or rectal misoprostol (400 mcg) or low-dose intravenous oxytocin (5 units oxytocin in 100 mL normal saline) for AMTSL. Data were recorded in three groups: Group A (methylergometrine), Group B (misoprostol), and Group C (oxytocin) consisting of 25 cases each. Results: Mean blood loss was found to be least in methylergometrine group (246.87 ± 65.44 mL) as compared to misoprostol (346.13 ± 58.35 mL) and oxytocin (334.5 ± 69.20 mL) ( P = 0.000) Mean duration of the third stage of labor was also least in methylergometrine group (6.21 ± 1.58 min) ( P = 0.0008). Conclusion: Although methylergometrine was found to have higher incidence of side effects such as nausea, vomiting, headache, and raised blood pressure, it was found to be the most effective drug for minimizing blood loss in the third stage of labor. In remote places where healthcare facilities are limited and drugs cannot be administered by parenteral route, rectal misoprostol remains an alternative.

A comparison of misoprostol with and without methylergometrine and oxytocin in outpatient medical abortion: a phase III randomized controlled trial

“…Various medical protocols are developed to prevent bleeding after surgical abortion or labor. However, these protocols are continuously modified to achieve better outcomes and higher success rates [ 31 – 33 ]. Even though there is no significant difference regarding the severity of bleeding in the three groups in our study, those given misoprostol plus methylergonovine showed mild bleeding compared to the other groups.…”

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

“…In a similar study methyl ergotamine was found to be more effective but had more side effects as well. 8,16,17 In a study done by Megha and colleagues misoprostol was found to be more effective in reducing blood loss as compared to Oxytocin and Meth ergotamine . 18 Various studies performed across the globe point towards difference in results.…”

Evaluation of In-Vitro Studies of the Shalmali Extract on Human Endometrial Stromal Cells

“…A variety of herbs have been found for treating gynecological diseases, such as irregular menses and heavy menstrual bleeding. Though studies have shown the beneficial effects of herbs on heavy menstrual bleeding, there is no comprehensive study on the effectiveness of herbs used for treating abnormal uterine bleeding [ 6 ].…”