Comparative Evaluation of Rectal Misoprostol versus Intravenous Oxytocin for the Prevention of Postpartum Hemorrhage

Vollständiger Abstract

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Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Active management of the third stage of labor significantly reduces blood loss. To compare the clinical efficacy and side-effect profile of 800μg rectal misoprostol versus 5 IU intravenous (IV) oxytocin for PPH prophylaxis following vaginal delivery. A randomized controlled trial was conducted at University Hospital, Tripoli, including 620 laboring women (310 per arm) undergoing normal singleton vaginal delivery. Following anterior shoulder delivery, Group 1 received 800μg rectal misoprostol plus IV saline, while Group 2 received 5 IU IV oxytocin infusion plus a rectal placebo. Primary outcomes included PPH incidence, hemoglobin/hematocrit changes at 24 hours, blood transfusion requirement, and adverse events. PPH incidence was comparable between the misoprostol and oxytocin groups (5.8% vs. 4.2%, p=0.33). No significant differences were observed in mean duration of the third stage (8.25±2.3 vs. 7.91±2.8 min, p=0.63), postpartum hematocrit drop ≥10% (2.3% vs. 2.6%, p=0.23), post-delivery hemoglobin (9.8±1.4 vs. 10.0±1.2 g/dL, p=0.76), or transfusion requirements (2.6% vs. 1.3%, p=0.33). Shivering (27.4% vs. 9.0%, p