Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: A randomized controlled trial

Owonikoko, Kola M.; Arowojolu, Ayodele O.; Okunlola, Michael A.

doi:10.1111/j.1447-0756.2010.01399.x

Cited by 39 publications

(51 citation statements)

References 28 publications

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“…These findings are consistent with some other researches [7,23]. Some mentioned oxytocinmediated hemodynamic changes in cesarean are decreasing blood pressure and peripheral vascular resistance plus increasing heart rate [26,27].…”

Section: Discussionsupporting

confidence: 82%

“…The sublingual route allows fast absorption of drug and more sustained therapeutic effect than oral administration as it avoids first-pass effect. Misoprostol stimulates uterine contractions by selectively binding to myometrial prostanoid receptors, and it has a long half life and minimal adverse effects, such as gastrointestinal symptoms, shivering, pyrexia, fatigue, and headache [7]. It is reported that sublingual misoprostol (800 lg) is a safe and effective treatment for women experiencing PPH [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Oxytocin and ergometrine are light-and heat-sensitive and require cold-chain storage. Prostaglandins E2 and F2a are used as second-or third-line agents but they are heat-labile and too expensive for use in developing countries [7]. Misoprostol, a synthetic prostaglandin E 1 analog, has been emerged to prevent and treat gastroduodenal damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs) [8].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Pakniat

Khezri

2015

J Obstet Gynecol India

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About the Author AbstractPurpose To compare the effect of combined oxytocinmisoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery. Methods One hundred fifty patients of 18-40 years with singleton term pregnancies scheduled for cesarean section under spinal anesthesia were recruited in a prospective double-blind randomized clinical trial to one of the three following groups to receive 20 IU infusion of oxytocin (group O), 400-lg sublingual misoprostol tablets (group M) or 200-lg misoprostol plus 5 IU bolus intravenous oxytocin (group MO) after delivery. The hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded. Results The mean blood loss during surgery was significantly lower in group MO compared to other groups (P = 0.04). Comparison of mean arterial pressure (P = 0.38) and heart rate (P = 0.23) changes during spinal anesthesia and surgery failed to reveal any statistically significant differences between all groups through repeated measure analysis. Conclusion The use of combined lower dose of misoprostol-oxytocin significantly reduced the amount of blood loss during and after the lower segment cesarean section compared to higher dose of oxytocin and misoprostol alone, and its use was not associated with any serious side effects.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Pakniat

Khezri

2015

J Obstet Gynecol India

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“…5,6 Misoprostol has been evaluated as an alternative to oxytocin during cesarean delivery, and has also been used in combination with oxytocin. [7][8][9][10][11][12][13][14][15][16][17] Two meta-analyses concluded that misoprostol was as effective as oxytocin and that the combination of the misoprostol and oxytocin is better than is oxytocin alone for the prevention of PPH. However, women with known risk factors for PPH, who are expected to benefit from an additional oxytocic agent, were excluded from some of the studies.…”

mentioning

confidence: 99%

Adjunctive sublingual misoprostol for secondary prevention of post-partum hemorrhage during cesarean delivery: double blind placebo randomized controlled trial

Sallam

Shady

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Cesarean delivery is the most frequently performed major operative procedure worldwide. Objective of present study was to evaluate randomized evidence regarding efficacy and safety of sublingual misoprostol for secondary prevention of post-partum hemorrhage during and after cesarean delivery in women receiving prophylactic oxytocin as primary preventive tools and bleed around 500ml by visual analogue estimation.Methods: A prospective, randomized, double-blind, placebo-controlled trial was performed at an obstetrics and gynecology department Aswan university hospital, Egypt, between October 2015 and September 2017. Women were eligible if they were undergoing elective cesarean under spinal anesthesia and were bleed around 500ml by visual analogue estimation. All participants received 10 IU oxytocin after delivery of the newborn. Participants were randomly assigned (1:1) to receive 400 μg misoprostol or matched placebo sublingually using a computer-generated random number sequence. Participants and providers were masked to assignment. The primary outcomes were intraoperative and postoperative blood loss.Results: There was high significant reduction in intraoperative blood loss in misoprostol group (711.0±188.41) compared with placebo group (915.33±293.72) (P=0.0001). The all estimated blood loss during CS and 24 hours postoperative was significant lower in misoprostol group (890.39±194.49) than that in placebo group (1096.9±300.05) (p=0.0001).Conclusions: Misoprostol as an adjunct to oxytocin as secondary prevention of pot partum hemorrhage seemed to be more effectively reduce blood loss than did placebo with oxytocin alone.

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“…The list of studies excluded is available from the authors upon request. Seventeen studies, 38-54 including 3174 women, fulfilled inclusion criteria of which seven evaluated misoprostol versus oxytocin (n=700), 39,40,42,45,47,49,54 one evaluated misoprostol versus ergometrine (n=374), 51 eight evaluated misoprostol plus oxytocin versus oxytocin (n=1918), 41,43,44,46,48,50,52,53 and one 3-arm trial evaluated misoprostol versus oxytocin versus misoprostol plus oxytocin (n=182). 38 …”

Section: Resultsmentioning

confidence: 99%

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

Conde-Agudelo

Díaz

Rosas-Bermúdez

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol versus oxytocin and 8 evaluated misoprostol plus oxytocin versus oxytocin. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, −2.1%; 95% confidence interval [CI], −3.4 to −0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% CI, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during caesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.

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Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: A randomized controlled trial

Cited by 39 publications

References 28 publications

The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Adjunctive sublingual misoprostol for secondary prevention of post-partum hemorrhage during cesarean delivery: double blind placebo randomized controlled trial

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

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