Management of third stage of labor with misoprostol: A comparison of three routes of administration

Background and Context: Misoprostol is a versatile drug with an effective uterotonic effect on the postpartum uterine tissue and is used through various routes during the third stage of labor. Aims and Objectives: A randomized prospective study was carried out to analyze the most effective route for misoprostol administration, with an emphasis on parturients′ acceptability and compliance, a possible shortening of the duration of the third stage of labor, minimization of blood loss and possibly reducing the incidence of potential side effects. Materials and Methods: The study groups comprised of 300 healthy parturients, divided randomly into three groups of 100 parturients each, who were administered misoprostol 400 mg through the oral (O), rectal (R), and sublingual (S) routes, respectively, during the third stage of labor. Estimation of blood loss was measured in terms of fall in hemoglobin, hematocrit, and packed cell volume (PCV) levels, and duration of the third stage of labor was also compared. Results: The mean duration for the third stage of labor was significantly shorter in group S (3.62 minutes) as compared to R (4.12 minutes), and O (4.94 minutes) ( P = 0.02). The average blood loss was observed to be the least in the group S (210 ml) as compared to group R (230 ml), and group O. The incidence of shivering and fever was observed to be significantly higher (25 and 15%) in the parturients of group S ( P < 0.05). Conclusions: All routes were equally effective in managing the third stage of labor, but administration of misoprostol through the rectal route evoked better acceptability, comparable efficacy, and had an incidence of minimal side effects