OBJECTIVE: To determine the efficacy of Carboprost versus methylergometrine maleate in the active management of third stage of labor for the prevention of postpartum hemorrhage.

METHODS: Entries in electronic databases with references cited in original studies and review articles were used to identify randomized clinical trials of carboprost versus methergin in the active management of third stage of labor. The quality of published clinical trials were evaluated and assessed based on the efficacy of Carboprost versus methylergometrine maleate for the prevention of postpartum hemorrhage.

RESULTS: Six (6) clinical trials were analyzed comprising a total sample pool of 525 women randomized to carboprost group and another 525 women to methergin. The risk ratio for dichotomous outcomes were calculated using a random-effects model while continuous outcomes were pooled using the standard mean difference. Results showed that both carboprost and methergin are both effective in preventing postpartum hemorrhage. But carboprost was found to be more efficacious in reducing the duration and decreasing the amount of blood loss in the third stage of labor and there was less need for an additional drug dose. Risks of side effects were higher in carboprost. Vomiting is the most frequent adverse event followed by diarrhea but are usually self-limiting.

CONCLUSION: Carboprost is well known for its therapeutic role in the management of postpartum hemorrhage, well-tolerated and with minimal adverse effects. It is therefore recommended to be used in hypertensive patients where methylergometrine maleate is contraindicated and in cases refractory to other uterotonic agents.