Author(s): Mundlapaty Sabitha1, Kona Sirisha2, Merugu Shyam Mohan Rao3
The third stage of labour is indeed the unforgiving stage of the labour and in it lurks more unheralded treachery than in both the other stages of labour combined. Many lifesaving drugs have been discovered and used for the management of this stage of labour. According to the WHO multicentric randomised trial using oral misoprostol with oxytocic, they concluded that oral misoprostol was associated with significantly high incidence of side effects like shivering and rise in body temperature and hence oxytocin is preferred to 600 mg of oral misoprostol in management of 3rd stage of labour in hospital settings, but still misoprostol has been suggested for the management of third stage of labour in developing countries, because it has strong uterotonic effects, can be given orally, inexpensive and does not need refrigeration. The aim of the study is to compare oxytocin, misoprostol, methylergometrine for active management of the third stage of labour.
MATERIALS AND METHODS
A total of 300 women of 37 weeks to 42 weeks of gestation delivering vaginally in Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh. 300 women allocated into 3 groups of 100 each to receive 10 IU I.M. oxytocin, 600 mcg sublingual misoprostol or 200 mcg I.M. methylergometrine, respectively. Primary outcome measure was blood loss in the third stage of labor; secondary measures were duration of the third stage, side effects and complications.
Subjects who received 600 mcg of misoprostol had the least blood loss (113 mL), followed by oxytocin and methylergometrine. The shortest mean duration of the third stage was with misoprostol (4.34 mins.). Shivering and pyrexia were observed in misoprostol group and raised blood pressure in methylergometrine group.
Misoprostol is as effective as oxytocin and both are more effective than methylergometrine in active management of the third stage of labour. Misoprostol therefore can be used in places where facilities of storage and parenteral administration of oxytocin is limited.