Rectal misoprostol versus intravenous oxytocin for the prevention of postpartum hemorrhage after vaginal delivery

OBJECTIVE: To compare rectally administered misoprostol to intravenously ad ministered oxytocin for the management of third-stage labor. STUDY DESIGN: Subjects were randomized to receive two, 200-mug misoprostol tablets rectally (study medication) plus 2 mL saline in Ringer's lactate in travenously or two lactose tablets rectally plus 20 units oxytocin in Ringe r's lactate intravenously (control medication). Blood loss was determined b y estimation, measurement, and change in hematocrit values from admission t o postpartum day 1. Subjects were excluded if cesarean delivery was require d. RESULTS: A total of 325 women underwent analysis. By estimation, 21 % of su bjects and 15% of controls had postpartum hemorrhage (P =.17). By using mea sured 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 (2 3%) misoprostol subjects and 18 (11%) oxytocin subjects at least one additi onal agent was required to control bleeding (P =.004). CONCLUSION: Rectal misoprostol (400 mug) was no more effective than intrave nous oxytocin in preventing postpartum hemorrhage.