Human Reproduction, Vol. 16, No. 1, 31-35,
January 2001
© 2001 European Society of Human Reproduction and Embryology
A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour
1 Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, 2 Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, and 3 Department of Obstetrics and Gynaecology Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
Postpartum haemorrhage accounts for nearly 28% of maternal mortality in developing countries. Syntometrine is an effective and commonly used oxytocic in preventing postpartum haemorrhage, but it requires a controlled storage environment and i.m. administration. Misoprostol is an orally active uterotonic agent. A total of 2058 patients having a singleton pregnancy, low risk for postpartum haemorrhage and vaginal delivery were randomized to receive either 1 ml syntometrine or 600 µg misoprostol for the management of the third stage of labour. There were no significant differences between the two groups in the mean blood loss, the incidence of postpartum haemorrhage and the fall in haemoglobin concentration. The need for additional oxytocic injection was significantly higher in the misoprostol group [relative risk (RR) 1.62, 95% confidence interval (CI) 1.34–1.96], but that of manual removal of placenta was reduced (RR 0.29, 95% CI 0.09–0.87). Shivering and transient pyrexia were more common in the misoprostol group. Oral misoprostol might be used in the management of the third stage, especially in situations where the use of syntometrine is contraindicated and facilities for storage and parenteral administration of oxytocics are limited.
Key words: misoprostol/syntometrine/third stage of labour
4 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. E-mail: pmyuen{at}cuhk.edu.hk
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