Active management of third stage of labour: misoprostol or oxytocin?

Document Type



Obstetrics and Gynaecology (East Africa)


The aim of this study was to compare the efficacy, safety and cost-effectiveness of rectal misoprostol and intramuscular oxytocin in the management of the third stage of labour using a randomized trial.

At Muhimbili National Hospital, Tanzania, 426 pregnant women in the active phase of labour were randomly selected to join the study. Twelve women were excluded from the study because their mode of delivery was caesarean section. Misoprostol 400 μg was administered rectally in 210 participants and intramuscular oxytocin at a dose of 5 IU in 204 participants respectively.

There was an equal mean estimated blood loss in both the misoprostol and oxytocin group (161 ml versus 169 ml) respectively. More women in the misoprostol group (18.1%) had a drop in haematocrit of >10% as compared to oxytocin (14.2%). A drop in haematocrit was more sensitive to detect postpartum hemorrhage as compared to estimated blood loss. Duration of the third stage of labour was similar in both groups: 8 minutes in the misoprostol group versus 8.7 minutes in the oxytocin group. The percentage of women who needed additional uterotonic drugs did not differ significantly: 7.4% in the oxytocin group and 4.3% in the misoprostol group (p=0.19).

Retained placenta occurred in 3.4% of the oxytocin group versus 1.4% of the misoprostol group (p=0.18). Shivering and nausea were the most prevalent side-effects in the misoprostol group (3.3%) and in the oxytocin group (2.9%).

Rectal misoprostol at a dose of 400 μg is as effective as 5 IU of oxytocin in the prevention of postpartum hemorrhage. The advantages of misoprostol are its heat stability and its ease in administration. It does not need storage in a refrigerator and can be used in both institutional and non-institutional deliveries.


This work was published before the author joined Aga Khan University.


African Journal of Midwifery and Women's Health