Management of Third Stage of Labour for Primigravidae with Singleton Pregnancies: Intravenous Oxytocin Alone vs Intravenous Oxytocin Combined with Sublingual Misoprostol

Abstract

The aim of this study is to compare and contrast the effectiveness of intravenous (IV) oxytocin alone and IV oxytocin combined with sublingually given misoprostol in managing the third stage of labor in primi gravid with singleton pregnancies who are giving birth vaginally.Study design: A randomized controlled trial Place and Duration: This study was conducted in Zulekha Hospital Sharjah   U.A.E from June 2022 to June 2023 Methodology: A total of 140 patients were enrolled in the study. The participants were allocated into two study groups: group A and group B. Each study group consisted of 70 enrolled patients. Eligible participants were primigravidae at term, with singleton pregnancies with gestational ages ranging from 37 to 41 weeks and experiencing spontaneous labor. Patients with instrumental vaginal deliveries, antepartum bleeding, antepartum haemorrhage, or any underlying medical conditions, including pregnancy-induced hypertension, were not included in the study. Group A received 10 IU of IV oxytocin combined with sublingual misoprostol (400 mcg), while Group B received 10 IU of IV oxytocin alone. The main outcome measure was the comparison of mean blood loss between the two study groups.Results: In our study, most participants were aged between 26 and 30 years. The oxytocin + misoprostol group had an average age of 26.8 ± 2.8 years, while the oxytocin alone group averaged 27.1 ± 2.3 years. Excessive bleeding (>500 ml) was seen in 14.28% of the oxytocin-only group and 5.71% in the oxytocin-and-misoprostol group. Mean blood loss significantly differed: 362.5 ml for oxytocin + misoprostol and 407.2 ml for oxytocin alone (p-value <0.001). Shivering occurred in 7.14% of the oxytocin + misoprostol group and 1.42% of the oxytocin alone group.Conclusion: The combination of IV oxytocin and sublingual misoprostol proved more potent than IV oxytocin alone in controlling the loss of blood during the third stage of labor. The amount of blood lost was notably lower in the patients given combination therapy when compared to patients administered IV oxytocin exclusively.