Oral misoprostol for third stage of labor: a randomized placebo-controlled trial

Objective: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. Methods: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 μg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. Results: Mean (± standard error of the mean) estimated blood loss (345 ± 19.5 mL versus 417 ± 25.9 mL, P = .031) and hematocrit difference (4.5 ± 0.9% versus 7.9 ± 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 ± 0.9 minutes versus 9 ± 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. Conclusion: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.