Randomized comparison of oral misoprostol and oxytocin in the third stage of labour

Bajzak, Krisztina (1999) Randomized comparison of oral misoprostol and oxytocin in the third stage of labour. Masters thesis, Memorial University of Newfoundland.

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Abstract

Objective: To test the null hypothesis that misoprostol, an oral prostaglandin El analog, is not worse than oxytocin intravenous bolus in minimizing blood loss in the third stage of labour. -- Method: One hundred and fifty-six women, having vaginal delivery and at low risk of postpartum hemorrhage, were stratified by oxytocin use in labour and randomly assigned to receive either misoprostol 200µg orally with the anterior shoulder, or oxytocin intravenous bolus after placental delivery, the standard at our institution. Sample size was calculated using a one-tailed α=0.05 and a power of 80%, with change in pre-delivery to 1st day postpartum hematocrit as the primary outcome. -- Results: Baseline demographic data were similar. There was no significant difference in the change in hematocrit between the misoprostol (0.046% packed cell volume[PCV]) and the oxytocin (0.048% PCV) groups (P=0.49). More women in the oxytocin stratum received additional oxytocin postpartum (P=0.002). There were no differences in the frequency of clinical estimate of postpartum blood loss greater than 500mL, use of other uterotonic agents, manual removal of placenta, dilation and currettage, transfusion, gastrointestinal side effects, or maternal satisfaction. There were no differences in frequency of maternal fever postpartum. After delivery, more women in the misoprostol group strongly preferred to have a medication in the form of a pill, rather than an intravenous injection, at the time of delivery of their baby (82.8% versus 42.2%, P<0.00001, Mann Whitney test) -- Conclusions: Oral misoprostol is a safe and effective option to minimize blood loss in the third stage of labour, for women at low risk of postpartum hemorrhage.

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