Comparative Evaluation of Rectal Misoprostol versus Intravenous Oxytocin for the Prevention of Postpartum Hemorrhage

Abstract

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Active management of the third stage of labor significantly reduces blood loss. To compare the clinical efficacy and side-effect profile of 800μg rectal misoprostol versus 5 IU intravenous (IV) oxytocin for PPH prophylaxis following vaginal delivery. A randomized controlled trial was conducted at University Hospital, Tripoli, including 620 laboring women (310 per arm) undergoing normal singleton vaginal delivery. Following anterior shoulder delivery, Group 1 received 800μg rectal misoprostol plus IV saline, while Group 2 received 5 IU IV oxytocin infusion plus a rectal placebo. Primary outcomes included PPH incidence, hemoglobin/hematocrit changes at 24 hours, blood transfusion requirement, and adverse events. PPH incidence was comparable between the misoprostol and oxytocin groups (5.8% vs. 4.2%, p=0.33). No significant differences were observed in mean duration of the third stage (8.25±2.3 vs. 7.91±2.8 min, p=0.63), postpartum hematocrit drop ≥10% (2.3% vs. 2.6%, p=0.23), post-delivery hemoglobin (9.8±1.4 vs. 10.0±1.2 g/dL, p=0.76), or transfusion requirements (2.6% vs. 1.3%, p=0.33). Shivering (27.4% vs. 9.0%, p<0.001) and transient fever ≥38∘C (13.9% vs. 6.1%, p<0.001) were significantly more frequent in the misoprostol group. Rectal misoprostol (800μg) provides prophylactic efficacy equivalent to IV oxytocin (5 IU) in reducing postpartum blood loss. Its thermostability and low cost make it an ideal alternative in resource-constrained obstetric settings.