• T S Gerstenfeld and D A Wing.
• Women's and Children's Hospital, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
• Am. J. Obstet. Gynecol. 2001 Oct 1; 185 (4): 878-82.

ObjectiveTo compare rectally administered misoprostol to intravenously administered oxytocin for the management of third-stage labor.Study DesignSubjects were randomized to receive two, 200-microg misoprostol tablets rectally (study medication) plus 2 mL saline in Ringer's lactate intravenously or two lactose tablets rectally plus 20 units oxytocin in Ringer's lactate intravenously (control medication). Blood loss was determined by estimation, measurement, and change in hematocrit values from admission to postpartum day 1. Subjects were excluded if cesarean delivery was required.ResultsA total of 325 women underwent analysis. By estimation, 21% of subjects and 15% of controls had postpartum hemorrhage (P =.17). By using measured blood loss, we determined that 70 of 154 (46%) study subjects and 61 of 161 (38%) control subjects had postpartum hemorrhage (P =.17). For 36 (23%) misoprostol subjects and 18 (11%) oxytocin subjects at least one additional agent was required to control bleeding (P =.004).ConclusionRectal misoprostol (400 microg) was no more effective than intravenous oxytocin in preventing postpartum hemorrhage.

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