A randomized clinical trial of preoperative versus postoperative misoprostol in elective cesarean delivery

Barakat, Rafik; Alsammani, Mohamed Alkhatim

doi:10.1016/j.ijgo.2015.06.057

Cited by 12 publications

(17 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A number of patients requiring additional uterotonic drugs were 38 in group 1 and 69 in group 2. Three patients in group 2 experienced blood loss of more than 1000 ml [22]. In contrast to our study, the total amount of blood loss in group 2 was much less than their study (656.76 ± 82.43 ml).…”

Section: Discussioncontrasting

confidence: 95%

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Youssef¹,

Khalifa²,

Bahaa³

et al. 2019

OJOG

View full text Add to dashboard Cite

Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS.

show abstract

Section: Discussioncontrasting

confidence: 95%

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Youssef¹,

Khalifa²,

Bahaa³

et al. 2019

OJOG

View full text Add to dashboard Cite

show abstract

“…Four studies 12,17,31,38 evaluated the preoperative misoprostol compared to postoperative misoprostol. These included 968 women (484 in each group).…”

Section: Preoperative Misoprostol Versus Postoperative Misoprostolmentioning

confidence: 99%

“…These advantages give misoprostol the priority to be the standard treatment for PPH in low resource areas. 17 A systemic evaluation of the use of misoprostol through different routes before and during CD is lacking.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of misoprostol in reducing intraoperative blood loss in women undergoing elective cesarean section. A systematic review and meta‐analysis

Maged

Wali

Salah

2022

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Objectives To evaluate the efficacy of misoprostol to minimized blood loss during and after cesarean delivery (CD). Search Strategy Screening of MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials from inception to February 2021 using the keywords related to misoprostol, CD, postpartum hemorrhage, and intraoperative blood loss and their MeSH terms. Selection criteria Only RCTs were included. Participants included women undergoing CD whether elective or selective. Thirty studies including 6593 women, 26 in English, 2 in Thai, 1 in French, and 1 in Chinese. Data Collection and Analysis Data from all selected studies were extracted independently by two authors. Data extracted included location of the trial, sample size, inclusion and exclusion criteria, participants characteristics, intervention details including timing, dose, and route of drug administration. Outcomes assessed included estimated intraoperative and postoperative blood loss, occurrence of postpartum hemorrhage, the need for additional uterotonics, and hemoglobin difference. Main Results Four studies (968 women) compared preoperative to postoperative misoprostol and found a mean difference in intraoperative blood loss of −205.00 (−339.22, −70.77), p = 0.003 and in postoperative blood loss −216.27 (−347.08, −85.46), p < 0.001 and a significantly lower need for additional uterotonics with a risk ratio of 0.54 (0.46, 0.64), p < 0.00001. Twenty‐two studies (4701 participants) compared misoprostol to oxytocin. There was a mean difference in intraoperative blood loss of −108.43 (−156.04, −60.82), p < 0.0001. Nine of these trials with 1978 participants evaluated postoperative blood loss. These found a mean difference of −64.12 (−116.19, −12.04) with a p = 0.02. Fourteen trials with 3166 participants measured the difference between preoperative and postoperative hemoglobin. These found a mean difference of −0.25 (−0.35, −0.15) with a p < 0.001. Twenty trials with 4416 participants measured the need for administration of additional uterotonics. These found a risk ratio of 0.62 (0.49, 0.78) with a p value of <0.001. Conclusion The combined use of misoprostol and oxytocin during CD is effective in reducing blood loss during and after CD.

show abstract

“…Rectal misoprostol is associated with slower absorption, longer duration of action and minimal side effects, hence considered as best route for patient undergoing caesarean delivery. Rectal misoprostol administration has mean T-max of 40 -65 minutes (6,7) and recent study showed T-max of 20 minutes which is much shorter. (8) If rectal misoprostol administered before caesarean section, the maximum effect was obtained by the end of surgery, as there is slower rate of absorption which is useful.…”

mentioning

confidence: 98%

“…(8) If rectal misoprostol administered before caesarean section, the maximum effect was obtained by the end of surgery, as there is slower rate of absorption which is useful. (7,9) As there is wide gap of controversy in the results of many studies about the use of misoprostol for prevention of postpartum haemorrhage with caesarean section and also route of misoprostol administration was not fully studied; Hence this study was conducted to compare the effects of preoperative administration of rectal misoprostol with IM oxytocin on reducing blood loss in caesarean section and to study side effects.…”

mentioning

confidence: 99%

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Garag¹,

Hadi²

2018

jemds

View full text Add to dashboard Cite

BACKGROUND Postpartum haemorrhage is a major cause of mortality and morbidity in pregnant women in developing countries. Caesarean section is associated with increased blood loss. Misoprostol is used as potent uterotonic agent that has been thoroughly studied in the prevention and treatment of PPH after vaginal delivery. However, role of preoperative rectal misoprostol in caesarean section for reducing blood loss is not studied much, hence this study was undertaken. MATERIALS AND METHODS This randomised controlled trial was performed between Jan 2017-July 2017 on 200 high-risk pregnant women coming to labour room of Department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubli, divided into two groups. The Group A (n= 100) received 400 μg of misoprostol. The Group B (n= 100) received 10U IM oxytocin after delivery as per hospital protocol. The primary outcome measures were amount of blood loss and change in haemoglobin level 24 hrs. after surgery. RESULTS The mean intraoperative blood loss was significantly lower in Group A (389 ± 172.56 mL) than Group B (445 ± 180.42 mL). The difference between the preoperative and postoperative haemoglobin value was also significantly lower in the misoprostol group (0.84) than the oxytocin group (1.10) with (p= 0.0300). Admissions to the neonatal intensive care unit were comparable between the two groups. CONCLUSION Preoperative administration of 400 μg rectal misoprostol significantly reduced blood loss compared to oxytocin in caesarean section without significant side effects and it can be used as an alternative to oxytocin.

show abstract

A randomized clinical trial of preoperative versus postoperative misoprostol in elective cesarean delivery

Abstract: Preoperative misoprostol (400μg, given rectally) reduces blood loss to a greater extent than does postoperative misoprostol during elective cesarean delivery. The frequency of complications was not affected by time of administration.

Cited by 12 publications

References 13 publications

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

The efficacy of misoprostol in reducing intraoperative blood loss in women undergoing elective cesarean section. A systematic review and meta‐analysis

Comparative Study of Rectally Administered Misoprostol After Spinal Anaesthesia Versus Routine Intramuscular Oxytocin for Reducing Blood Loss in Caesarean Section

Contact Info

Product

Resources

About