Comparison of Sublingual Misoprostol, Intravenous Oxytocin, and Intravenous Methylergometrine in Active Management of the Third Stage of Labor

Active management of the third stage of labor (AMTSL) is more effective in reducing postpartum hemorrhage than expectant management. Widespread implementation of AMTSL in remote and rural areas, however, is hampered by the lack of availability of an efficacious, easily administered, safe, and storable oxytocic. Two parenterally administered oxytocics, methyl ergometrine, and oxytocin, have a number of drawbacks in addition to their routes of administration. Methylergometrine is associated with the occurrence of life-threatening complications, and oxytocin requires careful handling and storage due to thermal- and photolability. In previous studies, a synthetic prostaglandin E1 analog, misoprostol has shown promise as an effective oxytocic agent. This agent is affordable, stable at room temperature, has a long-shelf, and can be administered orally or by other routes.