• Sami G Karkanis, David Caloia, Mary Ellen Salenieks, John Kingdom, Mark Walker, Filomena Meffe, and Rory Windrim.
• University of Toronto, Toronto, ON.
• J Obstet Gynaecol Can. 2002 Feb 1;24(2):149-54.

ObjectiveTo compare rectal misoprostol with oxytocin for routine management of the third stage of labour.Study DesignA total of 240 parturient women were randomized, at three University of Toronto teaching hospitals, to receive either rectal misoprostol (400 microg) after delivery of the infant or parenteral oxytocin (5 units i.v. or 10 units i.m.) with the delivery of the anterior shoulder, when possible, or 5 units i.v. or i.m after the delivery of the placenta. The primary outcome measure was change in hemoglobin (Delta[Hgb]) from admission in early labour to day one postpartum.SettingThe labour ward of three University of Toronto teaching hospitals: St. Michael's, Toronto General, and Mount Sinai.PopulationLabouring women either nulliparous or multiparous with no known risk for excessive third stage blood loss; vertex presentation; no previous Caesarean delivery; induced, spontaneous, or augmented labour.ResultsNo difference in Delta[Hgb] was observed between the two groups; the Delta[Hgb] in the oxytocin and misoprostol groups were 1.43 g/L (95% confidence interval [CI], 1.2-1.6 g/L) and 1.59 g/L (95% CI, 1.4-1.8 g/L) respectively (p = 0.35). Secondary outcome measures (excessive third stage bleeding, duration of third stage of labour, need for manual removal of the placenta or the need for additional oxytocics) did not differ between the two groups.ConclusionRectal misoprostol is of equivalent efficacy to parenteral oxytocin for the prevention of primary postpartum hemorrhage. Rectal misoprostol is an appropriate uterotonic agent for routine management of the third stage of labour.

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