Randomised controlled study to compare preoperative and postoperative effectiveness of rectal misoprostol for preventing blood loss in elective caesarean delivery

Priyanka Upadhyay, Iram Wani, Ruhina Khan


Background: Comparison between pre-operative and post-operative effectiveness of rectal misoprostol for preventing blood loss in elective caesarean delivery.

Methods: A single-blind randomized controlled study of 180 full-term pregnant women were scheduled for elective caesarean delivery. Computerized random allocation of women were done in group 1 to receive 400μg rectal misoprostol at urinary catheter insertion plus 400μg rectally after abdominal closure (preoperative group i.e. group 1, n=90) and group 2 who received 800μg of rectal misoprostol after abdominal closure (postoperative group i.e. group 2, n=90). Primary result was intraoperative blood loss.

Results: Intraoperative blood loss was significantly lower in the preoperative misoprostol group who was compared with the postoperative group (526.3±112.8 ml versus 735.4±135.7 ml; p<0.001). Postpartum hemorrhage (PPH) during the first 24 hours after delivery was also lower in the preoperative group against the post-operative group (205.1±77.4 ml versus 289.5±130.1 ml; p<0.001). Fewer women in the preoperative group needed additional uterotonics (8 versus 19; p<0.001) and after delivery, the decrease in haemoglobin levels was also significantly less in the preoperative group (−6.25 versus −14.28%; p<0.001).

Conclusions: Preoperative rectal administration of misoprostol significantly reduced intraoperative and postoperative blood loss during and after elective caesarean delivery.


Elective caesarean delivery, Intraoperative blood loss, Misoprostol, Postpartum haemorrhage, Randomized controlled trial, Rectal route

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