Background: Postpartum hemorrhage is a major cause of maternal mortality and morbidity. It has been identified that active management of third stage of labor is an effective way in preventing postpartum hemorrhage. This randomized controlled trial was conducted to compare sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage in nulliparous women.
Methods: In this randomized controlled trial conducted in Arash hospital from 2006 to 2009, Five hundred forty two nulliparous pregnant women were enrolled. They were randomized to receive either 400 microgram sublingual misoprostol or 20 IU oxytocin intravenously, immediately after the birth of newborn.
Results: Post partum Hemorrhage was significantly lower in women who received sublingual misoprostol (p<0.0001). Patients who received misoprostol had shorter length of third stage of labor (6.45 minute in misoprostol Vs 6.9 minute in oxytocin group, p=0.003). Comparison of hemoglobin levels in two groups before and after delivery showed that there is a significant lesser hemoglobin drop in misoprostol group p=0.046. Side effects were more common in misoprostol group (p<0.0001). However, they were not serious; shivering (35.66%) in misoprostol group and headache (9.63%) in oxytocin group were the most common adverse effects.
Conclusions: Sublingual misoprostol is more effective than intravenous oxytocin in preventing postpartum hemorrhage and is recommended for prevention of postpartum hemorrhage.