Main Article Content

Mehtab Shah
Heera Urooj
Shazma Shah
Rehana Rahim


Objective: To compare the efficacy of rectal misoprostol with intravenous oxytocin in prevention of postpartum hemorrhage (PPH) in elective cesarean section (CS) operation.

Methodology: This randomized controlled trial was conducted in the Department of Obstetrics & Gynecology Department, Lady Reading Hospital, Peshawar. A total of 334 women undergoing elective CS were recruited in the study through consecutive sampling and randomly allocated to misoprostol group (group A) and IV oxytocin group (Group B). Follow up was done to determine the mean blood loss in both groups to determine the efficacy in terms of presence or absence of postpartum hemorrhage.

Results: The mean age in group A was 31.2±6.8 years compared to 30±6.2 years in group B. The mean blood loss in group A was 776±285.7 ml, while in group B it was 817±1318 ml. Efficacy of rectal misoprostol was 83.8% as compared to 74.9% for I/V Oxytocin with a significant p-value of 0.043.

Conclusion: Rectal misoprostol in women prepared for elective cesarean section show better efficacy in terms of PPH prevention as compared to IV oxytocin.

Article Details

How to Cite
Shah M, Urooj H, Shazma Shah, Rahim R. EFFICACY OF RECTAL MISOPROSTOL VS INTRAVENOUS OXYTOCIN IN PREVENTING POSTPARTUM HEMORRHAGE FOLLOWING ELECTIVE CAESAREAN SECTION. J Postgrad Med Inst [Internet]. 2021 Sep. 30 [cited 2024 Jul. 23];35(3):131-5. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/2780
Original Article


Nagasree MGS, Smitha A. Misoprostol versus oxytocin in prevention of post¬partum hemorrhage. Int J Basic and Applied Med Sci. 2015; 5(1):180- 5

Edhi MM, Aslam HM, Naqvi Z, Hashmi H. Post partumhaemorrhage: causes and management. BMC Res Notes. 2013; 6(1):236.

Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum hemor-rhage. Cochrane Database Syst Rev. 2014;(2):CD003249.

World Health Organization. WHO rec¬ommendations for prevention and treat¬ment of postpartum hemorrhage. Gene¬va: WHO; 2012.

Bhutto A. Rectal misoprostol versus in¬travenous syntometrine in active third stage of labour in low risk women. Med Channel. 2012; 18(4):40-3.

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. Pre¬vention and management of postpar¬tum hemorrhage. Int J Obstet Gynecol. 2016; 124:106-49.

Conde A, Nieto A, Rosas A. Misoprostol to reduce intraoperative and postopera¬tive hemorrhage during cesarean deliv¬ery: a systemic review and meta-anal¬ysis. Am J Obstet Gynecol. 2013; 209(1):40-7.

Fazel MR, Mansoure S, Esmaeil F. A comparison of rectal misoprostol and intravenous oxytocin on hemorrhage and homeostatic changes during cesar¬ean section. Middle East J Anaesthesiol. 2013; 22(1):41-6.

Vagge DS. A comparative study to as¬sess the efficacy and tolerability of per rectal misoprostol and intravenous oxytocin in prevention of primary post¬partum haemorrhage in a tertiary care hospital. J Chem Pharm Res. 2014; 6(3):1134-40.

Begley CM, Gyte CM, Devane D, Mc¬Guire W, Weeks A. Active versus expect¬ant management for women in the third stage of labour. Cochrane Database Syst Rev. 2011; 11:CD007412.

Dyer RA, Butwick AJ, Carvalho B. Oxy¬tocin for labour and cesarean delivery: implications for anaesthesiologist. Curr Opin Anaesthesiol. 2011; 24:255-61.

Unterscheider J, Breathnach F, Geary M. Standard medical therapy for postpar¬tum hemorrhage. In: A comprehensive textbook of postpartum hemorrhage. London: Sapiens Publishing; 2012. p. 355-60.

Mirteimouri M, Tara F, Teimouri B, Sakhavar N, Vaezi A. Efficacy of rectal misoprostol for prevention of postpar¬tum hemorrhage. Iran J Pharm Res. 2013; 12(2):469–74.

Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Da¬tabase Syst Rev. 2000; (3):CD000007.

Jackson KW, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. 2001; 185:873–7.

Rizvi F, Mackey R, Barrett T, McKenna P, Geary M. Successful reduction of mas¬sive postpartum haemorrhage by use of guidelines and staff education. Int J Obstet Gynecol. 2004; 111:495–8.

Lam H, Tang OS, Lee CP. A pilot-ran¬domized comparison of sublingual misoprostol with syntometrine on the blood loss in third stage of labor. Acta Obstet Gynecol Scand. 2004; 83:647.

Miller S, Lester F, Hensleigh P. Pre¬vention and treatment of postpartum hemorrhage: new advances for low-re¬source settings. J Midwif Womens Health. 2004; 49:283–292.

Schaff EA, Dicenzo R, Fielding SL. Com¬parison of misoprostol plasma concen¬trations following buccal and sublingual administration. Contraception. 2005; 71:22–25.

World Health Organization. Mother baby package: implementing safe mother¬hood in countries. Geneva: WHO; 1998.

Roach MK, Abramovici A, Tita AT. Dose and duration of oxytocin to prevent postpartum hemorrhage: a review. Am J Perinatol. 2013; 30:523e8.

Fujimoto M, Takeuchi K, Sugimoto M, Maruo T. Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methyler¬gometrine in the management of the third stage of labor. Acta Obstet Gynecol Scand. 2006; 85:1310e4.

Chaudhuri P, Biswas J, Mandal A. Sub¬lingual misoprostol versus intramuscu¬lar oxytocin for prevention of postpar¬tum hemorrhage in low- risk women. Int J Gynaecol Obstet. 2012; 116:138e42

Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, et al. Miso¬prostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial. Int J Obstet Gynaecol. 2005; 112: 1277–83.

Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor com¬munities: a randomised controlled trial. Lancet. 2006; 368:1248–53.

Gülmezoglu AM, Villar J, Ngoc NT, Piag¬gio G, Carroli G, Adetoro L, et al. WHO multicentre randomised trial of miso¬prostol in the management of the third stage of labour. Lancet. 2001; 358: 689–95.

Langenbach, C. Misoprostol in pre¬venting postpartum hemorrhage: a meta-analysis. Int J Obstet Gynaecol. 2006; 92:10–8.

Sloan NL, Durocher J, Aldrich T, Blum J, Winikoff B. What measured blood loss tells us bout postpartum bleeding: a systematic review. Int J Obstet Gynae¬col. 2010; 117:788–800.