Effects of Preoperative Sublingual Misoprostol on Uterine Tone during Isoflurane Anesthesia for Cesarean Section

El-Tahan, Mohamed R.; Warda, Osama; Rashad, Amal; Yasseen, A.M.; Ramzy, Eiad A.; Ahmady, Mona S.; Diab, Douaa G.; Matter, Mohamed

doi:10.1016/s0034-7094(12)70162-9

Cited by 12 publications

(12 citation statements)

References 28 publications

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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.…”

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confidence: 99%

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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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confidence: 99%

“…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. [12][13][14]16,17 Thus, the existing evidence on the optimal uterotonic agent during cesarean for high-risk women is insufficient.…”

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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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“…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%

“…The most common dose used in studies evaluating the sublingual route was 400 g, and 800 g in studies that evaluated the rectal and intrauterine routes. Misoprostol was used after delivery of the neonate in 12 studies and before delivery of the neonate in five studies (orally 38 or rectally 47 at the time of peritoneal incision, rectally just before onset of cesarean section 51 or after urinary catheter placement, 52 and sublingually after tracheal intubation 53 ). It should be noted that in seven studies that compared misoprostol with placebo, all women received an intravenous infusion of oxytocin in doses ranging from 5 IU to 20 IU.…”

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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“…Misoprostol is now being used prophylactically to maintain uterine tone during C-section under anesthesia and to reduce blood loss during myomectomy for fibroids [32,33]. In 1995, and again in 2012, misoprostol was evaluated for its ability to reduce oral mucositis in response to chemotherapy and radiation [34,35].…”

Section: Lipids Used As Therapeutic Pharmacologic Agentsmentioning

confidence: 99%

Emerging targets in lipid-based therapy

Tucker

Honn

2013

Biochemical Pharmacology

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The use of prostaglandins and NSAIDS in the clinic has proven that lipid mediators and their associated pathways make attractive therapeutic targets. When contemplating therapies involving lipid pathways, several basic agents come to mind. There are the enzymes and accessory proteins that lead to the metabolism of lipid substrates, provided through diet or through actions of lipases, the subsequent lipid products, and finally the lipid sensors or receptors. There is abundant evidence that molecules along this lipid continuum can serve as prognostic and diagnostic indicators and are in fact viable therapeutic targets. Furthermore, lipids themselves can be used as therapeutics. Despite this, the vernacular dialog pertaining to “biomarkers” does not routinely include mention of lipids, though this is rapidly changing. Collectively these agents are becoming more appreciated for their respective roles in diverse disease processes from cancer to preterm labor and are receiving their due appreciation after decades of ground work in the lipid field. By relating examples of disease processes that result from dysfunction along the lipid continuum, as well as examples of lipid therapies and emerging technologies, this review is meant to inspire further reading and discovery.

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Effects of Preoperative Sublingual Misoprostol on Uterine Tone during Isoflurane Anesthesia for Cesarean Section

Abstract: Preoperative administration of sublingual misoprostol 400μg is safe and effective in attenuating the maternal bleeding and uterine atony from isoflurane anesthesia for cesarean delivery.

Cited by 12 publications

References 28 publications

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

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

Emerging targets in lipid-based therapy

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