Active management of third stage of labor by intravenous ergometrine and rectal versus sublingual misoprostol (a double-center study)

Background: Active management of third stage of labor is a feasible and inexpensive intervention that helps saving thousands of women’s lives. Objective: The aim of the study was to compare the efficacy of IV ergometrine, rectal versus sublingual misoprostol in active management of third stage of labor. The same protocol was applied to Al-Jomhoria Hospital, Garunis University, Benghazi, Libya. Methods: The study was conducted on 300 primigravida (150 Alexandria University El-Shatby Maternity Hospital, 150 in Al-Jomhoriya Hospital, Benghazi University) who underwent normal vaginal delivery and were divided into 3 groups according to the drug used in management of third stage of labor (ergometrine IV, one rectal tablet of misoprostol, one sublingual tablet of misopristol) All patients were closely observed for time of placental delivery, amount of blood loss by Hb and hematocrit value pre and immediately post delivery (within 1 h), use of oxytocin and any recorded side effects. Results: During the follow up of Alexandria Jamhoriya cases, it was found: 200 mcg sublingual misopristol was more effective than 200 mcg rectal misopristol and IV ergometrine immediately after delivery, as it decreased the amount of blood loss [mean estimated blood loss in IV ergometrine group was 331.2 ml/320.33, rectal misopristol group was 310.7/305.9, sublingual misopristol group was 227.6/270.01, respectively. P1= 0.001*, P2= 0.001*/P1= 0.036*, P2= 0.045*]. The most common side effects occurred in sublingual misopristol group 8% had fever, 30% had shivering in Alexandria group and 98% had shivering in Jamhoriya group. Conclusion: Misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage. Sublingual misopristol is a more effective uterotonic drug in management of third stage of normal labor than IV ergometrine and rectal misoprostol.