Low-dose sublingual misoprostol versus methylergometrine for active management of the third stage of labor

Objective: To compare the efficacy and side-effects of low-dose sublingual misoprostol and i.v. methylergometrine for active management of the third stage of labor. Methods: The study subjects were three hundred low-risk women with term pregnancy and spontaneous onset of labor. These women received either one (100 mu g/tablet) or two tablets of misoprostol (200 mu g) sublingually or 1 mL (200 mu g) of methylergometrine, i.v. injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were the need for additional oxytocic drugs, blood loss >= 500 mL, change in hemoglobin levels and side-effects. Results: Post-partum hemorrhage (>= 500 mL blood loss) did not occur in any of the women, but above-average bleeding occurred in 2.0% of cases in groups I, II (sublingual misoprostol 100 mu g and 200 mu g respectively) and III (methylergometrine), despite additional oxytocics used in 5.0%, 4.0% and 3.0% cases in groups I, II and III respectively (P > 0.05). The change in hemoglobin levels at 24 h post-partum were 0.8%, 0.7% and 0.8% in groups I, II and III respectively (P > 0.05). Conclusion: A low dose of sublingual misoprostol appears to be as effective as a low dose of i.v. methylergometrine in the prevention of post-partum hemorrhage in low-risk cases. So given the advantages of its stability at room temperature, low cost and easy route of administration, misoprostol appears to be a better choice, and a low dose is enough. However, larger studies in low-risk as well as high-risk cases are needed to advocate routine use of a low dose at the primary level.