A Comparative Study to Assess the Efficacy and Safety of Oxytocin, Misoprostol and Carboprost In Active Management of Third Stage of Labour at A Tertiary Care Hospital

Abstract

Background: Third stage of labour is the most perilous for woman because of the risk of postpartum haemorrhage (PPH) and the primary cause being uterine atony. Active management of the third stage of labour is a well-established protocol.

Objectives: To assess the efficacy and safety of oxytocin, misoprostol and carboprost in active management of third stage of labour.

Methods: One hundred and eighty pregnant women with term gestation were recruited and randomised into three groups. Group A received intravenous infusion of 10U of oxytocin in 500ml normal saline, Group B received 600µg of Misoprostol per rectally and Group C received 125µg of Carboprost intramuscularly at the delivery of anterior shoulder of the baby. Primary outcomes were duration of third stage, amount of blood loss and incidence of PPH.

Results: Misoprostol and carboprost were associated with shorter durations of the third stage of labor (5.16 ± 1.85 and 5.25 ± 1.73 minutes, respectively) compared with oxytocin (6.43 ± 2.6 minutes). Blood loss was also significantly lower in the carboprost group (157.41 ± 49.43 ml) than in the misoprostol (183.25 ± 51.93 ml) and oxytocin (206.16 ± 56.81 ml) groups. Additionally, the carboprost group required the fewest additional uterotonic agents and experienced the smallest decreases in hemoglobin and hematocrit levels.

Conclusion: This study highlights the superior uterotonic profile of carboprost 125µg compared to other agents studied. Prophylactic carboprost may therefore be a valuable alternative for the active management of the third stage of labor.