Comparison of the Effectiveness of Rectal Misoprostol with I/V Oxytocin in Prevention of Postpartum Hemorrhage

Abstract

Objective: Prevention of Postpartum Hemorrhage (PPH) was evaluated by comparing the efficacy of rectal misoprostol with intravenous oxytocin in a tertiary-care obstetric setting.

Methods: This prospective, randomized controlled trial (RCT) was conducted at Obstetrics and Gynecology Department of Jinnah Postgraduate Medical Center, Karachi, from June 2025 to December 2025. Pregnant women aged 15 to 40 years, gestational age > 37 weeks, with singleton live pregnancy and duration of labour of 24 hours, parity of less than 5 kids, who were scheduled for normal vaginal deliveries with induced labour, spontaneous labour or augmented labour, without clinical evidence of active antepartum hemorrhage and preoperative hemoglobin level of ≥10 g/dL were included. Patients were subsequently allocated equally into the two treatment groups (A& B). Patients of group A received rectal misoprostol 600 µg and the patients of group B received intravenous oxytocin 10 IU only. Total blood loss was assessed immediately after delivery using a calibrated collection container and by weighing blood-soaked pads/gauze. Subsequently women were monitored for 24 hours for further evidence of postpartum bleeding, and a volume of >500 mL of blood loss was considered as PPH. SPSS version 26 was used for data analysis.

Results: All the enrolled patients (50 misoprostol, 41 oxytocin) showed comparable baseline demographic and obstetric characteristics between groups (p>0.05). The misoprostol group found with significantly reduced PPH incidence (2.0% vs. 14.6%) and mean blood loss (299.9 ± 80.4 mL vs. 408.6 ± 125.4 mL) compared to oxytocin group (p<0.05), with less mechanical procedures need and transfusions rate (2.0% and 9.8%). Conversely the misoprostol administration was linked to a higher rate of non-significant side effects including fever, shivering and the gastrointestinal side effects (p>0.05). The mean blood loss was differed significantly according to age groups (p=0.038), being highest in the 25–35 years, while incidence of PPH incidence and hemoglobin levels showed insignificant age-related association (p>0.05).

Conclusion: Rectal administration of misoprostol showed more hemostatic efficacy in the prevention of postpartum bleeding, whereas oxytocin appears to carry a more favorable short-term tolerability profile.

Keywords: Misoprostol; Oxytocin; PPH; Vaginal delivery, Prevention