Introduction
At all levels of childbirth, especially in the third stage of labor, it is important to prevent excessive bleeding (postpartum hemorrhage). Chemical compounds that increase the contractions of muscles of the uterus (uterotonics) include intramuscular Oxytocin and oral Misoprostol. Uterotonics helps with postpartum blood loss and therefore plays an important role in managing postpartum hemorrhage at the third stage of labor.
What Is the Third Stage of Labor?
The third stage of labor is the time from the baby's delivery to the ejection of the placenta and the amniotic membranes. It is at this stage of labor that the baby is born. This stage of labor usually lasts for about 30 minutes. In this final stage of childbirth, the pulse of the umbilical cord stops, the membrane separates from the wall of the uterus, and the placenta and the amniotic membranes pass through the birth canal. The amount of blood loss in the third stage of labor depends on the time of the placental separation from the uterine wall and the effectiveness of uterine muscle contraction in the period of postpartum (time after childbirth).
How Is the Third Stage of Labor Managed?
One of the main complications associated with third-stage labor is the occurrence of postpartum hemorrhage. Postpartum hemorrhage (PPH) is severe bleeding that occurs after childbirth and is one of the leading causes of maternal death. PPH can occur after deliveries up to 12 weeks postpartum. Active management of the third stage of labor includes methods that are developed to prevent the occurrence of postpartum hemorrhage. These methods mainly try to prevent uterine atony and facilitate placental delivery. Uterine atony is the most common cause of PPH, and it occurs when the uterus fails to contract adequately during the delivery of the placenta. Other complications of the third stage of labor can be retained placenta, uterine inversion (complication during delivery, where the uterus turns inside out), and lacerations of the genital tract. Medications like Oxytocin and Misoprostol are given during the third stage of labor to help the uterus contract, thereby minimizing the risk of complications.
What Is Oral Misoprostol?
Misoprostol is a compound that bears a resemblance to a naturally occurring lipid compound called prostaglandins. Prostaglandins are hormones present in the body that helps in contractions during delivery. Misoprostol can be given in various routes, like orally, vaginally, or rectally.
How Is Oral Misoprostol Used to Manage the Third Stage of Labor?
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Misoprostol is used for inducing labor and also in the management of PPH.
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Misoprostol has a long shelf life and can be administered through multiple routes, which makes it easy to use in low-resource settings with limited medical personnel.
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Misoprostol can be given orally and requires no special administration training.
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It does not require special storage facilities and is stable in hot environments, making it favorable to use in rural areas.
What Is 10 IU Intramuscular Oxytocin?
A 10 intramuscular Oxytocin is an oxytocin of 10 IU (international units) administered intramuscularly, mainly on the thigh muscles. Doctors use manufactured or synthetic Oxytocin to induce contractions and facilitate childbirth if it has not started naturally. Synthetic Oxytocin is also used to fasten the delivery of the placenta (third stage of labor), reducing the incidences of postpartum hemorrhage.
How Is Intramuscular Oxytocin Used to Manage the Third Stage of Labor?
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Oxytocin is the standard drug for preventing and treating postpartum hemorrhage.
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Oxytocin reduces the risk of postpartum hemorrhage and the need for a blood transfusion after the baby's birth.
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It requires refrigeration, sterile equipment, and a trained person; therefore, using Oxytocin in low-resource settings can be difficult.
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Within one minute of birth, after the baby's delivery, oxytocin 10 IU is administered intramuscularly into the thigh muscles.
What Are the Similarities Between Oral Misoprostol and 10 Intramuscular Oxytocin?
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Oral Misoprostol is as safe and effective as intramuscular Oxytocin for managing blood loss during the third stage of labor.
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Both Oral Misoprostol and Intramuscular Oxytocin have side effects.Misoprostol has more side effects like nausea, vomiting, shivering, and intermittent fever than Oxytocin.
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The side effects of Misoprostol, like fever and shivering, are mostly self-limiting and are caused due to the prostaglandin effect on the central thermoregulatory center. Side effects like shivering could be easily controlled by simply covering the pregnant patient with a blanket.
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Changes in the hematological parameter, like the fall in hemoglobin level, are reliable for assessing blood loss during delivery. In the pre-delivery level, no significant difference in the hemoglobin change was noted in patients who were given oral Misoprostol or intravascular Oxytocin.
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There was no significant difference in the pre or post-delivery level of hematocrit (the percentage of red blood cells present in the body) of patients treated with Oxytocin or Misoprostol.
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Oral Misoprostol and intramuscular Oxytocin can cause complications like retained placenta, blood transfusion due to uncontrolled bleeding, uterine evacuation or exploration, and more uterotonic drugs.
What Are the Differences Seen in Oral Misoprostol and Intramuscular Oxytocin?
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In postpartum hemorrhage, the blood loss is at least 500 ml within the first 24 hours of delivery, whereas, in a severe postpartum hemorrhage, the blood loss will be greater than 1000 ml within the first 24 hours of delivery. To control severe postpartum hemorrhage in a hospital setting, oral Misoprostol is not as effective as intravascular Oxytocin.
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Oral Misoprostol is an inexpensive, safe, and effective uterotonic with a long shelf life that can be used in rural and remote areas. In contrast, the availability of intramuscular Oxytocin is comparatively less.
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Oral Misoprostol does not need special training for its administration and has an acceptable safety profile compared to intramuscular Oxytocin, which requires trained personnel.
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The post-delivery hemoglobin level of patients who were given oral Misoprostol was lower than that of patients with 10 IU intramuscular Oxytocin.
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Oral Misoprostol is effective in high-risk patients with pregnancy-induced hypertension, bronchial asthma, and rhesus-negative blood groups where other oxytocics are usually contraindicated.
Conclusion
Both oral Misoprostol and intramuscular Oxytocin are uterotonics or compounds that play an important role in managing the third stage of labor and its complications, especially postpartum hemorrhage. The doctor will decide which uterotonic is better for the patient, depending on their availability and the delivery setting. Both oral Misoprostol and intramuscular Oxytocin can effectively help manage the third stage of labor.
