The misoprostol third stage of labour study: a randomised controlled comparison between orally administered misoprostol and standard management

Objective To compare misoprostol with standard oxytocic regimens in the prevention of postpartum haemorrhage. Design Randomised controlled trial. Setting Obstetric unit in a large teaching hospital. Methods One thousand women randomised to 500 μg misoprostol given orally or to standard oxytocic regimens of oxytocin, oxytocin with ergometrine, or ergometrine. Main outcome measures Incidence of postpartum haemorrhage and the incidence and severity of side effects. Results Postpartum haemorrhage occurred in 12% of women given misoprostol and in 11% of women given standard oxytocic drugs (relative risk (RR) 1.10, 95% confidence interval (CI) 0.79, 1.55). Blood loss of 1000 mL or more occurred in 2% of women in each group. Nausea, headache, dizziness and tiredness were less frequent with misoprostol (RR (95% CI) 0.71 (0.59, 0.84); 0.53 (0.38, 0.74); 0.73 (0.61, 0.87) and 0.88 (0.83, 0.94) respectively). The main side effects of misoprostol were shivering (RR 1.95, 95% CI 1.69, 2.25) and a rise in temperature (difference in mean rise 0.34°C, 95% CI 0.26, 0.42). Conclusion Oral misoprostol for the prevention of postpartum haemorrhage was comparable to standard oxytocics. Many side effects were less common with misoprostol but shivering and pyrexia were more common. Larger randomised trials are needed before establishing the equivalence between misoprostol and standard oxytocic drugs in the prevention of postpartum haemorrhage.