A Comparative Study Between Preoperative Rectal Misoprostol and Intraoperative Intrauterine Administration in the Reduction of Blood Loss During and After Cesarean Delivery: A Randomized Controlled Trial

Elsherbini, Moutaz; Maged, Ahmed M.; Helal, Omneya Mostafa; Awad, M.O.; El-Attar, Sally A; Sadek, J; Elkomy, Rasha; Dawoud, Magdy

doi:10.1097/01.aoa.0000796196.30132.44

Cited by 2 publications

(3 citation statements)

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“…The weight difference of soaked towels in both groups was comparable. Our findings are similar to but lower weight difference of soaked towels in the study [21].…”

Section: Discussionsupporting

confidence: 90%

“…The most common indication for LSCS was fetal distress followed by cord prolapse in both groups. The pre-operative hemoglobin was comparable between the two groups while the post-operative hemoglobin in Group I and Group II was found to be highly significant (p value < 0.01) which were comparable with [16,20,21] showed that the mean drop in hemoglobin was not significantly different between the two groups which is contrary to our study [22].…”

Section: Discussioncontrasting

confidence: 74%

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The Efficacy and Safety of Intrauterine Misoprostol During Cesarean Section in Prevention of Primary Post-Partum Hemorrhage - A Randomized Controlled Trial

2022

IJOG

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Postpartum hemorrhage remains the most common cause of maternal death globally [1]. and has persisted in low-income countries due to the prevalence of home deliveries and limited access to life-saving uterotonic drugs in these countries [2-5]. Many of the global gains in reducing maternal mortality can be attributed to developments in preventing and treating Postpartum Hemorrhage (PPH) [6,7]. PPH is often associated with the failure of the uterus to contract after delivery and is categorized as blood loss of 500 mL or more following a vaginal delivery or 1,000 mL after cesarean delivery [8,9]. PPH is categorized as primary if it occurs within 24 hours of delivery and secondary if excessive blood loss occurs at 24 hours or more after delivery. To compare the efficacy and safety of intrauterine misoprostol with intravenous oxytocin during Cesarean Section (CS) in prevention of primary post-partum hemorrhage. A total of 150 pregnant women at term (37-40 weeks) gestation who were scheduled for either elective or emergency caesarean delivery were enrolled. They were equally randomized into two groups: women who received 400mcg intrauterine misoprostol in addition to intravenous infusion of 10 IU oxytocin as Group I while women who received an intravenous infusion of 10 IU oxytocin after delivery of the neonate as Group II. The Primary outcome measures were Estimated Blood Loss (EBL) during caesarean section and need for additional uterotonic drugs intraoperatively. Secondary outcomes included the occurrence of excessive blood loss (>1000mL) within the first 6 hours postoperatively and the occurrence of any maternal or fetal side effects. The difference in the postoperative haemoglobin and postoperative hematocrit was found to be highly significant between the two groups (10.12 ± 1.55 vs 9.24 ± 1.52; p < 0.01) and (2.48 ± 1.38 vs 3.75 ± 1.77; p < 0.001) respectively. Estimated blood loss in two groups was found to be very highly significant (440.19 ± 257.75 vs 677.38 ± 343.04; p < 0.001). Intraoperative blood loss was significantly lower in the group I compared to group II (408.27 ± 123.34 vs 486.04 ± 135.84; p < 0.001). Blood loss during the first 6 hours after delivery was also lower in the group I (58.87 ± 9.86 mL vs 63.29 ± 12.39 mL; p < 0.05). Fewer women in the intrauterine misoprostol group needed additional uterotonics (7 vs 11; p > 0.05). The difference in the side effects of both the groups was found to be statistically non-significant. Apgar scores at 1 and 5 minutes were comparable in both the groups. The combined use of intrauterine misoprostol (400 mg), when added to oxytocin infusion during caesarean section is effective in decreasing the intraoperative blood loss, post-operative blood loss and prevent postpartum hemorrhage. keywords: Intrauterine misoprostol; Intraoperative estimated blood loss; Cesarean section; Postpartum hemorrhage

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“…The weight difference of soaked towels in both groups was comparable. Our findings are similar to but lower weight difference of soaked towels in the study [21].…”

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 74%

The Efficacy and Safety of Intrauterine Misoprostol During Cesarean Section in Prevention of Primary Post-Partum Hemorrhage - A Randomized Controlled Trial

2022

IJOG

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“…Based on the current study, participants who were administered with rectal Misoprostol preoperatively had lower Apgar scores at 1 & 5 min compared to those treated with intrauterine Misoprostol. The present finding agrees with the study of El-Sherbini et al [16] , who observed that the combined usage of Misoprostol with oxytocin intrauterine or rectally lowers operational blood loss and PPH as effectively as the use of either agent alone. Misoprostol has no side effects other than shivering, fever, and nausea, regardless of whether a rectalintrauterine route of administration is used.…”

Section: Majed Et Alsupporting

confidence: 93%

Prostaglandin E1 Analog: Comparison between Two Different Routes of Administration for the Prevention of Post-Partum Hemorrhage

Elghazaly

2022

International Journal of Medical Arts

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Article informationBackground: Postpartum hemorrhage [PPH] is considered as the major cause of maternal death worldwide. A Prostaglandin E1 analog, Misoprostol, has been demonstrated to be useful in lowering intra and postoperative blood loss. However, the proper timing of administration is still up for debate.Objective: Comparative study of Prostaglandin E1 analog [misoprostol] administration via two distinct routes: preoperative rectal and intraoperative intrauterine administration to reduce blood loss during and after cesarean delivery.Patients and Methods: This is a randomized clinical trial that involved 100 pregnant women attending Alzhraa University Hospital, all of them were eligible for elective cesarean section. All participants were randomized into two groups: Group [1]: which involved 50 women who received 400 ug misoprostol intrauterine intraoperative, and Group [2]: which involved 50 women who received 400 ug misoprostol rectally preoperative. Results:The two groups were not statistically significant different regarding the amount of blood loss or the occurrence of postpartum hemorrhage P-value [P<0.05]. The Apgar scores were considerably higher in the intrauterine Group compared to the rectal Group at both 1 and 5 minutes. Conclusion:Both preoperative rectal and intraoperative intrauterine administration of Misoprostol [400ug] have the same effect on the amount of blood loss during caesarean delivery; however, it is more convenient to be administrated during caesarean delivery with a safer neonatal outcome.

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A Comparative Study Between Preoperative Rectal Misoprostol and Intraoperative Intrauterine Administration in the Reduction of Blood Loss During and After Cesarean Delivery: A Randomized Controlled Trial

Cited by 2 publications

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The Efficacy and Safety of Intrauterine Misoprostol During Cesarean Section in Prevention of Primary Post-Partum Hemorrhage - A Randomized Controlled Trial

The Efficacy and Safety of Intrauterine Misoprostol During Cesarean Section in Prevention of Primary Post-Partum Hemorrhage - A Randomized Controlled Trial

Prostaglandin E1 Analog: Comparison between Two Different Routes of Administration for the Prevention of Post-Partum Hemorrhage

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