The effectiveness of sublingual misoprostol in prevention of bleeding during cesarean delivery

Document Type : Original Article

Authors

1 Gynecologists, School of Medicine, Baghiatollah University of Medical Sciences, Tehran, Iran.

2 Associate professor, Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Misoprostol is a potent uterotonic agent which has been reported to be useful in the prevention and treatment of postpartum hemorrhage; but limited studies have been performed about its effect during cesarean section and prevention from postpartum hemorrhage. This study was performed with the aim to assess the effectiveness of sublingual misoprostol in prevention of bleeding during cesarean delivery.
Methods: This randomized clinical trial was performed on 186 women who were candidate for cesarean delivery in Tajrish Shohada Hospital during 2008. The women were randomly placed in two groups of misoprostol+ oxytocin and placebo+ oxytocin. The women randomly received 400-microg misoprostol subligually or placebo immediately after cord clamp. All patients also recieved a dilute intravenous oxytocin infusion at delivery. final variable was determining intra-operative blood loss by differences of the preoperative and postoperative hemoglobin and hematocrit concentration. Data was analyzed using SPSS statistical software (version 15) and t test, chi-square or Fisher's exact tests. PResults: Two groups were not significantly different in terms of mean age, parity, gestational age, fetus weight, indications for cesarean section, the duration of operation, and other intrapartum variables, and also the preoperative and postoperative hemoglobin and hematocrit values (P>0.05). But, drop in hemoglobin 1.01±1.19 in intervention group vs. 1.32±1.74 mg/dl in control group and P= 0.002; and drop in hematocrit 2.97%±3.29% in intervention group vs. 3.18%±4.87% in control group, and P=0.001, it means that in misoprostol group, drop in hemoglobin and hematocrit were significantly lower compared to placebo group. Also, need to additional uterotonic agent was significantly lower in misoprostol group (18.8% vs 47.31%; P=0.001). There was not a significant difference between two groups in terms of need to transfusion or the incidence of drug's side effects (P>0.05).
Conclusions: Sublingual misoprostol reduces the intra-operative blood loss during cesarean section and also, the need for additional uterotonic agents; however, this reduce in blood loss does not decrease transfusion rate.

Keywords

References

  1. Cunningham G, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2010.
  2. Ugwu IA1, Enabor OO, Adeyemi AB, Lawal OO, Olayemi O. Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial. J Obstet Gynaecol 2014; 34(5):407-11.
  3. Fuks AM1, Khanna P, Yusaf T, Aslian A, Kowalska D, Salafia CM. Use of prophylactic misoprostol in reduction of blood loss at vaginal delivery. Obstet Gynecol 2014;123(Suppl):144S-5S..
  4. Rajaei M1, Karimi S1, Shahboodaghi Z1, Mahboobi H2, Khorgoei T3, Rajaei F4. Safety and efficacy of misoprostol versus oxytocin for the prevention of postpartum hemorrhage.J Pregnancy 2014;2014:713879.
  5. Mirteimouri M1, Tara F, Teimouri B, Sakhavar N, Vaezi A. Efficacy of rectal misoprostol for prevention of postpartum hemorrhage
  6. Iran J Pharm Res 2013;12(2):469-74..
  7. Aziz S, Kazi S, Haq G, Soomro N. Oral misoprostol versus oxytocin in the management of third stage of labour. J Pak Med Assoc. 2014; 64(4):428-32
  8. Acharya G, Al-Sammarai MT, Patel N, Al-Habib A, Kiserud T. A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section. Acta Obstet Gynecol Scand 2001; 80(3):245-50.
  9. Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section. Int J Gynaecol Obstet 2006; 92(2):106-10.
  10. Zhao Y, Li X, Peng Y. Clinical study on reduction of postpartum bleeding in cesarean section by misoprostol. Zhonghua Fu Chan Ke Za Zhi 1998;33(7):403-5
  11. Hamm J, Russell Z, Botha T, Carlan SJ, Richichi K. Buccal misoprostol to prevent hemorrhage at cesarean delivery: a randomized study. Am J Obstet Gynecol. 2005; 192(5):1404-6.
  12. Lapaire O, Schneider MC, Stotz M, Surbek DV, Holzgreve W, Hoesli IM. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet 2006; 95(1):2-7.
  13. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynaecol Obstet 2007; 99 (Suppl 2):S160-7.

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