Sublingual misoprostol to reduce blood loss at caesarean delivery


  • Shonali N. Agarwal Department of Obstetrics and Gynaecology, Baroda Medical College, M. S. University, Vadodara, Gujarat, India
  • Nidhi D. Thakkar Department of Obstetrics and Gynaecology, Baroda Medical College, M. S. University, Vadodara, Gujarat, India



Lower segment caesarean section, Post-partum haemorrhage, Sublingual misoprostol


Background: Caesarean section is the most common obstetrical procedure performed worldwide. Sometimes oxytocin alone is not sufficient to prevent postpartum haemorrhage and additional uterotonics may be required. We attempted an additional uterotonic misoprostol by sublingual route to evaluate the role of it to reduce blood loss at caesarean delivery.

Methods: This prospective clinical study was done on patients of S. S. G. Hospital, Baroda; 138 patients who underwent lower segment caesarean section (elective or emergency). The primary outcome was less intra/peri operative blood loss, need for additional uterotonic agents and perioperative haemoglobin (Hb) fall. The secondary outcomes studied were incidence of shivering, pyrexia, nausea, vomiting, operating time, blood transfusion, endomyometritis and hospitalization period. Average blood loss after normal vaginal delivery is 500 ml and after caesarean delivery is around 1000 ml.

Results: Mean postoperative Hb was high with misoprostol group and perioperative Hb fall was less. Perioperative Hb fall of 1 g or more was lesser in this group.

Conclusions: Sublingual misoprostol reduces intraoperative blood loss, perioperative blood loss and the need for additional uterotonic agents and blood transfusions at caesarean delivery.



Ashraf AH, Ramadani HM. Assessment of Blood Loss During Cesarean Section Under General Anesthesia and Epidural Analgesia Using Different Methods. AJAIC. 2006;9(1):25-34.

Siwatch S, Kalra J, Bagga R, Jain V. Sublingual vs Vaginal Misoprostol for Labor Induction. J Postgrad Med Edu Res. 2012;46(3):138-43.

Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol. 2002;99(3):502-6.

Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med. 2001;344(1):38-47.

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.

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.

Lokugamage AU, Sullivan KR, Niculescu I, Tigere P, Onyangunga F, El Refaey H, Moodley J, Rodeck CH. A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary postpartum haemorrhage. Acta Obstet Gynecol Scand. 2001;80(9):835-9.

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.

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.

Bahadur A, Khoiwal K, Bhattacharya N, Chaturvedi J, Kumari R. The effect of intrauterine misoprostol on blood loss during caesarean section. J Obstet Gynaecol. 2019;39(6):753-6.

Kumari KA, Swathi E, Saranu S. Impact of pre-operative 200 mcg (P/R0 per rectal misoprostol on blood loss during and after Cesarean delivery. IAIM. 2016;3(6):49-58.

Abd-Ellah AH, Tamam AAE, Khodry MM. Is the Time of administration of misoprostol of value? The uterotonic effect of misoprostol given pre- and post-operative after elective cesarean section. Middle East Fertility Soc J. 2014;19(1):8-12.

Ugwu IA, Enabor OO, Adeyemi AB, Lawal OO, Oladokun A, Olayemi O. Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial. J Obstet Gynaecol. 2014;34(5):407-11.

Maged AM, Fawzi T, Shalaby MA, Samy A, Rabee MA, Ali AS, Hussein EA, Hammad B, Deeb WS. A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective cesarean delivery. Int J Gynaecol Obstet. 2019;147(1):102-7.

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.

Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology. 1974;41(6):609-12.

Fekih M, Jnifene A, Fathallah K, Ben Regaya L, Memmi A, Bouguizene S, Chaieb A, Bibi M, Khairi H. Benefit of misoprostol for prevention of postpartum hemorrhage in cesarean section: a randomized controlled trial. J Gynecol Obstet Biol Reprod (Paris). 2009;38(7):588-93.






Original Research Articles