Noviyati Rahardjo Putri, Anis Laela Megasari


Background: Maternal mortality rate in Indonesia has decreased from 184/100,000 live birth (LB) (2016) to 177/100,000 LB (2017), but this number is still high enough than SDGs target of 70/100,000 LB. The one of direct cause of maternal death is hemorrhage, especially postpartum hemorrhage (PPH). Causes of PPH are uterine atony, laceration of birth canal, resistant placenta and uterine inversion. PPH prevention method is Active Management of Third Stage of Labor (AMTSL). The objective of this systematic review is to analyze the use of uterotonics in AMTSL.

Methods: This systematic review used the PRISMA protocol, articles taken from Google Scholar, Science Direct, and Pub Med. The time span of the research article was 2010 to 2021.

Result: The results of the study describe that the use of uterotonics in single use or combination in third stage of labor can reduce the risk of PPH and shorten the time of the stage. The side effects were reported in misoprostol and methyl ergometrine than oxytocin. In addition, combination therapy with oxytocin and misoprostol can reduce the length of the third stage and the potential for a decrease in hemoglobin within 24 hours of delivery. In Indonesia, if oxytocin is not available, maternal nipple stimulation is performed as nonpharmacological therapy or ergometrine 0.2 mg is given to patients without complications of high blood pressure.

Conclusion: The use of uterotonics is adjusted to its cost-effectiveness, ability to store and refrigerate also the benefits compare to the side effects to the patients.


active management of the third stage, uterotonics, postpartum, hemorrhage

Full Text:



  1. Gallos I, Williams H, Price M, Pickering K, Merriel A, Tobias A, et al. Uterotonic drugs to prevent postpartum haemorrhage: A network meta-analysis. Health Technol. Assess. (Rockv). 2019;23.
  2. Leduc D, Senikas V, Lalonde AB, Leduc D, Ballerman C, Biringer A, et al. Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. J. Obstet. Gynaecol. Canada [Internet] 2009;31:980–93. Available from: http://dx.doi.org/10.1016/S1701-2163(16)34329-8
  3. Geni PL, Rachman IT, Pradjatmo H. Peran Penambahan Misoprostol Pada Penatalaksanaan Aktif Kala Tiga Dalam menurunkan Perdarahan Pascapersalinan. J. Kesehat. Reproduksi 2017;4:170–7.
  4. Revinel. Comparative Effectiveness of the Third Stage of Labor Between Administration of Rectally Misoprostol and Oxytocin Intramuscular. Pustaka Unpad [Internet] 2014;1–9. Available from: http://pustaka.unpad.ac.id/wp-content/uploads/2014/10/Revinel-Artikel.pdf
  5. Antonius Y, Hartono E, Malinta U. Perbandingan Jumlah Perdarahan dan Lama Kala III Persalinan Menggunakan Misoprostol Sublingual dengan Oksitosin Intramuskular pada Grandemultipara. JST Kesehat. 2011;1:152–7.
  6. Mukta M, Sahay PB. Role of Misoprostol 600 mcg Oral in Active Management of Third Stage of Labor: A Comparative Study with Oxytocin 10 IU i.m. J. Obstet. Gynecol. India [Internet] 2013;63:325–7. Available from: http://link.springer.com/10.1007/s13224-012-0330-x
  7. Quibel T, Ghout I, Goffinet F, Salomon LJ, Fort J, Javoise S, et al. Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage. Obstet. Gynecol. [Internet] 2016;128:805–11. Available from: https://journals.lww.com/00006250-201610000-00017
  8. Olkamien. Perbandingan Managemen Aktif Kala III dan Konvensional di RSU Sinar Kasih Tentena. J. Ilmu Kesehat. 2014;1:750–8.
  9. Chandnani KA, Sharma DD. Third stage of labour: expectant versus active management-a comparative study in local low risk population. Int. J. Reprod. Contraception, Obstet. Gynecol. 2019;8:641.
  10. Boopathi A, Nayak SR, Rao A, Rao B. Oxytocin versus Methylergometrine in the Active Management of Third Stage of Labour. Open J. Obstet. Gynecol. 2014;04:666–71.
  11. Supe P, Kore S, Nandanwar Y. A comparative study of efficacy of misoprostol with methyl ergometrine and carboprost in active management of third stage of labour. Int. J. Reprod. Contraception, Obstet. Gynecol. 2016;5:1525–31.
  12. Rahim AYHA, Ounsa MAAGE, Albarakati RG, Mohamed EY, Abdalla SM. Comparison between oxytocin, ergometrine and misoprostol in active management of the third stage of labour: a randomized controlled trial. Int. J. Reprod. Contraception, Obstet. Gynecol. 2018;7:2076.
  13. Begley CM, Gyte GML, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst. Rev. 2019;2019.
  14. WHO. WHO recommendations: Uterotonics for the prevention of postpartum haemorrhage [Internet]. 2018. Available from: http://apps.who.int/bookorders.%0Ahttps://www.who.int/reproductivehealth/publications/uterotonics-pph/en/
  15. Lalonde A. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int. J. Gynecol. Obstet. [Internet] 2012;117:108–18. Available from: http://doi.wiley.com/10.1016/j.ijgo.2012.03.001
  16. Adi Kusuma M, Wiryana M, Hariyasa Sanjaya IN, Widnyana IMG. Perbandingan Efek Oksitosin Bolus 3 IU, 5 IU, dan 10 IU Terhadap Kontraksi Uterus dan Respon Kardiovaskular Pada Seksio Sesarea dengan Anestesi Blok Subaraknoid. Medicina (B. Aires). 2014;44:143–9.
  17. Müller-Schweinitzer E, Tapparelli C. Methylergometrine, an Active Metabolite of Methysergide. Cephalalgia [Internet] 1986;6:35–41. Available from: http://journals.sagepub.com/doi/10.1046/j.1468-2982.1986.0601035.x
  18. Cuppett CD, Caritis SN. Uterine Contraction Agents and Tocolytics [Internet]. In: Clinical Pharmacology During Pregnancy. Elsevier; 2013. page 307–30.Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780123860071000192
  19. Desrini S. The benefit and Risk Of Misoprostol Use : in Obstetrics and Gynecology. J. Kedokt. dan Kesehat. Indones. 2015;7:25–9.
  20. Gallos I, Williams H, Price M, Merriel A, Gee H, Lissauer D, et al. Uterotonic agents for preventing postpartum haemorrhage : a network meta-analysis ( Review ) SUMMARY OF FINDINGS FOR THE MAIN COMPARISON. Cochrane Database Syst. Rev. 2018;
  21. Bilgin Z, Kömürcü N. Comparison of the effects and side effects of misoprostol and oxytocin in the postpartum period: A systematic review. Taiwan. J. Obstet. Gynecol. [Internet] 2019;58:748–56. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1028455919302098


  • There are currently no refbacks.