Abstract
Background: Numerous randomized trials have compared the use of uterotonic agents with placebo or other uterotonics. However, limited data exist regarding the relative efficacy of injectable oxytocin versus sublingual misoprostol in preventing postpartum hemorrhage. Furthermore, local studies comparing these two agents have yielded inconsistent findings.
Objective: To compare the efficacy of sublingual misoprostol and injectable oxytocin for the prophylaxis of primary postpartum hemorrhage.
Material and Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, Maula Bukhsh Teaching Hospital, Sargodha, Pakistan, over a period of six months following synopsis approval (February to August 2024). A total of 120 patients meeting the inclusion criteria were enrolled after approval from the institutional Ethical Review Board. Participants were randomly divided into two equal groups (n=60 each) using a computer-generated random number table. Group A received 600 μg of sublingual misoprostol, while Group B received 10 IU of intramuscular oxytocin. All patients were managed according to WHO guidelines, including controlled cord traction, fundal massage, and 24-hour postpartum monitoring. Blood loss was assessed using the gravimetric method with pre-weighed materials. Data were collected on a standardized proforma.
Results: The mean age was slightly higher in Group B (32.55 ± 7.45 years) compared to Group A (32.08 ± 7.29 years). The mean gestational age was comparable between Group A (38.57 ± 1.19 weeks) and Group B (38.52 ± 1.17 weeks). Among women in Group A, 33.3% had given birth once compared to 30% in Group B, while 41.7% in Group A and 33.3% in Group B had given birth twice. Group A had a higher percentage of participants with no history of abortion or stillbirth. With regard to efficacy, 90% of participants in the misoprostol group (Group A) achieved effective prophylaxis compared to 75% in the oxytocin group (Group B), demonstrating a statistically significant difference (p = 0.031). Stratified analysis further indicated that efficacy remained consistently higher in Group A across multiple subgroups, including older age categories, higher parity, and participants without a history of abortion or stillbirth.
Conclusion: This research indicates that sublingual misoprostol is often more efficacious than injectable oxytocin for the prevention of primary postpartum hemorrhage. With 90% of participants in the misoprostol group reporting positive outcomes compared to 75% in the oxytocin group, the findings suggest that misoprostol may be a preferable alternative for postpartum hemorrhage prophylaxis, particularly in resource-limited settings.
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