DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220908

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

Abstract


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.


Keywords


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

Full Text:

PDF

References


Sweed MS, El-Saied MM, Abou-Gamrah AE. Rectal vs. sublingual misoprostol before cesarean section: Double-blind, three-arm, randomized clinical trial. Arch Gynecol Obstet. 2018;298:1115-22.

Maged AM, Helal OM, Elsherbini MM. A randomized placebo‐controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery. Int J Gynecol Obstet. 2015;131:265-68.

Hernández-Castro F, López-Serna N, Treviño-Salinas EM, Soria-López JA, Sordia-Hernández LH, Cárdenas-Estrada E. Randomized double-blind placebo-controlled trial of buccal misoprostol to reduce the need for additional uterotonic drugs during cesarean delivery. Int J Gynecol Obstet. 2016;132:184-7.

Sharafi A, Ghasemi M. Comparison of rectal misoprostol's effect when used before and after a cesarean section on post-cesarean bleeding. J Gynecol Obstet Hum Reprod. 2019;48:129-32.

Ragab A, Barakat R, Alsammani MA. A randomized clinical trial of preoperative versus postoperative misoprostol in elective cesarean delivery. Int J Gynecol Obstet. 2016;132:82-4.

Gavilanes P, Morales MF, Velasco S, Teran E. Sublingual misoprostol is as effective as intravenous oxytocin to reduce intraoperative blood loss during cesarean delivery in women living at high altitude. J Matern Fetal Neonatal Med. 2016;29:559-61.

Khan RU, El-Refaey H. Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003;101(5):968-74.

Elsedeek MS. Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery. Int J Gynecol Obstet. 2012;118:149-52.

Owonikoko KM, Arowojolu AO, Okunlola MA. Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in nigeria: A randomized controlled trial. J Obstet Gynecol Res. 2011;37:715-21.

Chaudhuri P, Mandi S, Mazumdar A. Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing postpartum hemorrhage after cesarean delivery. J Obstet Gynecol Res. 2014;40:2023-30.

Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149-60.

Ercan CM, Coksuer H, Karasahin KE, Alanbay I, Aydogan U, Parlak A, Baser I. Comparison of different preoperative sublingual misoprostol regimens for surgical termination of first trimester pregnancies: a prospective randomized trial. J Reprod Med. 2011;56(5-6):247-53.

Fiala C, Aronsson A, Granath F, Stephansson O, Seyberth HW, Watzer B, Gemzell-Danielsson K. Pharmacokinetics of a novel oral slow-release form of misoprostol. Hum Reprod. 2005;20(12):3414-8.

El-Refaey H, Rodeck C. Post-partum haemorrhage: Definitions, medical and surgical management. A time for change. Br Med Bull. 2003;67:205-17.

Lagenbach C. Misoprostol in preventing postpartum hemorrhage: A meta-analysis. Int J Gynecol Obstet. 2006;92:10-8.

Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: Pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynecol Obstet. 2007;99(2):160-7.

Abd-Ellah AH, Tamam AAK. 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 Fertil Soc J. 2014;19:8-12.