INTRAMUSCULAR OXYTOCIN VERSUS SUBLINGUAL MISOPROSTOL AS A COMPONENT OF ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR FOR PREVENTION OF PRIMARY POST-PARTUM HAEMORRHAGE

BACKGROUND Post-partum haemorrhage is one of the common causes of maternal mortality and morbidity worldwide. Active management of labour is the key element in prevention of post-partum bleeding and complication of third stage of labour. Use of uterotonics is mandatory for prevention of primary post-partum haemorrhage. Many drugs like oxytocin, misoprostol, ergometrine alone or in combination are used as uterotonic drugs. Our aim is to compare the efficacy and safety of intramuscular oxytocin and sublingual misoprostol as an uterotonic agent used to minimise post-partum bleeding. MATERIALS AND METHODS 800 selected antenatal mothers fulfilling the inclusion and exclusion criteria were divided non-randomly into two equal groups of 400 each by using computerised generated randomisation chart. One group received 400 mcg of sublingual misoprostol and the other group received intramuscular oxytocin after the delivery of the baby as a component of active management of third stage of labour for prevention of primary atonic PPH. The efficacy and side effects of the two drugs were assessed. This study found both sublingual misoprostol and intramuscular oxytocin to be effective in prevention of primary PPH with oxytocin being slightly better than misoprostol, but those with misoprostol had significantly higher incidence of fall of haemoglobin and PCV and significantly higher incidence of fever. Hypotension, though more common with oxytocin, was not found to be significantly higher than in patients treated with misoprostol. On the contrary, mean fall of SBP and DBP was significantly more in the misoprostol group. This study established that both misoprostol and oxytocin are equally effective in prevention of primary PPH with oxytocin slightly better than misoprostol. Misoprostol can be used as an alternative to oxytocin in low resource areas. Both oxytocin and misoprostol are capable of minimising blood loss in 90% of the individuals. RESULTS This study found both sublingual misoprostol and intramuscular oxytocin to be effective in prevention of primary PPH with oxytocin being slightly better than misoprostol, but those with misoprostol had significantly higher incidence of fall of haemoglobin and PCV and significantly higher incidence of fever. Hypotension, though more common with oxytocin was not found to be significantly than those treated with misoprostol. On the contrary, mean fall of SBP and DBP was significantly more in the misoprostol group. CONCLUSION This study established that both misoprostol and oxytocin are equally effective in prevention of primary PPH with oxytocin being slightly better than misoprostol. Misoprostol can be used as an alternative to oxytocin in low resource areas. Both oxytocin and misoprostol are capable of minimising blood loss in 90% of the individuals.