Comparison of the effects of intramuscular methylergonovine, intravascular oxytocin, and sublingual misoprostol in active management of the third stage of labor

Document Type : Original Article


Department of Obstetrics & Gynecology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objective: Postpartum hemorrhage is a common obstetric complication and a major cause of maternal mortality. Uterotonic drugs are used to prevent abnormal postpartum hemorrhage. Known uterotonic agents include methylergonovine, oxytocin, and prostaglandins. This study compares the effect of these three agents on prevention of abnormal postpartum hemorrhage.
Subjects and Methods: This randomized clinical trial was carried out on 150 pregnant women with singleton pregnancies, live fetuses and without previous medical history, during 2010. Mothers were randomly divided into three groups each comprised of 50 cases. Cases in the first group received 400 µg sublingual misoprostol; the second group, 0.2 mg intramuscular methylergonovine; and the third had 20 units of oxytocin, intravenous infusion in 1 liter ringer solution immediately after delivery of the newborn’s anterior shoulder. Descriptive statistics was used to present indices (mean value, standard deviation); t-test and variance analysis was used to compare mean values.
Results: The duration of the third stage of labor, hemoglobin fall 24 hours after parturition, and the amount of hemorrhage during third and fourth stages of labor were compared amongst the three aforementioned groups, which yielded no statistically significant difference between them (P > 0.05). Low grade fever (38°C) was observed in two of the cases given misoprostol which subsided following administration of 2-3 liters of crystalloids. No other side effects were seen in the other two groups.
Conclusion: Oxytocin, methylergonovine, and misoprostol are equally effective in prevention of postpartum hemorrhage.


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