Publication:

A comparative study of various oxytocics in management of third stage of labour

Background Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, with a global incidence of 2-11% following vaginal delivery. Active management of the third stage of labour (AMTSL) through prophylactic uterotonic administration is the cornerstone of PPH prevention. Comparative data on oxytocic agents from Indian tertiary care settings remain limited.

Methods A prospective observational study was conducted at the Department of Obstetrics and Gynecology, Government Medical College, Akola, Maharashtra, from February 2024 to March 2026. A total of 224 women with uncomplicated term vaginal deliveries were allocated to five groups: Group A-Oxytocin 10 IU IM; group B-Misoprostol 600 µg sublingual; group C-Methylergometrine 0.2 mg IM; group D-Carboprost 250 µg IM; group E-Carbetocin 100 µg IV. Primary outcomes were duration of the third stage, haemoglobin (Hb) drop, and time to uterine tone. Secondary outcomes included side effects, blood transfusion requirement, and need for repeat dosing.

Results Carbetocin demonstrated the shortest third stage (3.93 min), fastest uterine tone (1.86 min), lowest Hb drop (0.43 g/dL), no blood transfusions, lowest side effect rate (4.7%), and lowest repeat dose requirement (2.3%). Oxytocin and methylergometrine showed comparable efficacy. Misoprostol had the longest third stage (6.17 min), slowest uterine tone (8.47 min), and highest side effect rate (26.1%). Carboprost was effective but associated with a higher side effect burden (23.9%).

Conclusions Carbetocin demonstrated superior efficacy and tolerability for AMTSL. Oxytocin remains the recommended first-line agent given its safety and cost profile. Misoprostol is viable in resource-limited settings despite its higher side effect rate.