Impact of Preoperative Rectal Misoprostol on Blood Loss during and after Elective Cesarean Delivery: A Randomized Controlled Trial

Sitaula, Sarita; Uprety, D; Thakur, Achala; Pradhan, Tarun

doi:10.3126/njog.v11i2.17460

Cited by 3 publications

(3 citation statements)

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“…However, this insignificant difference is due to estimating the blood loss based on deficit in hemoglobin level pre and postoperative as the sufficient data about number of towels used and the amount of blood in surgical suctions during cesarean delivery is lacked. This finding agrees with Sitaula S. et al (2017) who found that carbetocin was superior to misoprostol in decreasing intraoperative blood loss [20] .…”

Section: Discussionsupporting

confidence: 92%

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

Moustafa¹,

Elhady

Shalaby

et al. 2020

Evidence Based Women's Health Journal

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Aim: This study aimed to compare the use of misoprostol to carbetocin in reducing blood loss during cesarean section in low risk patients. Materials and Methods: This randomized controlled study enrolled 300 patients who were eligible. 150 women received carbetocin100ug i.v intra-operative immediately after extraction of the fetus during cesarean section (group A). They were compared to 150 women who received misoprostol 600ug rectally immediately before sterilization during caesarean section (group B). Results: There is significant difference in intraoperative uterine atony [3 (2.0%) vs 11 (7.3%) P < 0.02] and the need for blood transfusion [2 (1.2%) vs 10 (6.7%) P > 0.018] and surgical hemostatic measures as uterine artery ligation and uterine compression sutures [0.00 vs 3.00 (2%) P < 0.00 and 0.00 vs 12.00 (8%) P < 0.00] were higher in misopristol group. Also, the need for other uterotonic drugs was significantly higher in misopristol group (10.0 ± 0.0 vs 13.15 ± 5.28, P < 0.001 and the difference in hemoglobin and hematocrit values before and after delivery were slightly higher in misopristol group with no statistical significance (

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Section: Discussionsupporting

confidence: 92%

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

Moustafa¹,

Elhady

Shalaby

et al. 2020

Evidence Based Women's Health Journal

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“…Though primary prevention with oxytocin is being practiced widely, it is not always effective and the need of additional or adjuvant uterotonics is reported to be 10-40%. 9,10 The logic pertaining to the choice of adjuvant utertonic, timing, dose and route used in the present study was in accordance to recent evidence while formulating an innovative approach of using administration of adjunct misoprostol in selective group of parturient as discussed below:…”

Section: Discussionsupporting

confidence: 53%

“…The efficacy of misoprostol alone as well as an adjunct to oxytocin for prevention of PPH is well documented. [9][10][11][12][13][14][15][16][17][18][19][20] In contrast very few studies have reported a contrary view but have used a lower dose. 21 Choosing the optimal dose is imperative to achieve the goal as discussed later.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Mishra

Nekkanti

Barma

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: To evaluate the effect of adjunctive misoprostol in preventing postpartum haemorrhage (PPH) by selective administration above threshold bleeding in order to reduce its side effects in comparison with primary prevention with oxytocin alone.Methods: It was a prospective observational cohort study conducted at Government medical College of central India. Population included 500 low risk women delivering vaginally. After having received oxytocin as primary prevention, women were monitored for bleeding by quantitative assessment of blood loss (QBL) using an innovative drape (kept prepared at the point of care) and once bleeding crossed 350 ml mark, alternate women were given 800 µg misoprostol sublingually as an adjuvant (study group) and compared with those who did not receive adjuvant misoprostol (control group). Main outcome measure: Comparing the incidence of PPH and side effects between study and control group.Results: 150 women had blood loss >350 ml which constituted 76 women in study and control group each. Incidence of PPH was significantly less in the study group (10.52 versus 22.36%, p<0.05, RR 0.470 95% CI= 0.216-1.024). Though side effects were more (38.15%) in study group but these were mild in nature and when the number was extrapolated to all recruited women, the incidence came down to 11.6%.Conclusions: Sequential adjuvant misoprostol at 350 ml blood loss after primary prevention with oxytocin is an effective and pragmatic strategy for preventing PPH when compared to oxytocin alone but with reduced overall side effects owing to less number of women receiving misoprostol.

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Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

Gallos

Papadopoulou

Man

et al. 2018

Cochrane Database of Systematic Reviews

131

183

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Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic agents can prevent PPH, and are routinely recommended. The current World Health Organization (WHO) recommendation for preventing PPH is 10 IU (international units) of intramuscular or intravenous oxytocin. There are several uterotonic agents for preventing PPH but there is still uncertainty about which agent is most effective with the least side effects. This is an update of a Cochrane Review which was first published in April 2018 and was updated to incorporate results from a recent large WHO trial. Objectives To identify the most effective uterotonic agent(s) to prevent PPH with the least side effects, and generate a ranking according to their effectiveness and side‐effect profile. Search methods We searched the Cochrane Pregnancy and Childbirth’s Trials Register, , the World Health Organization (WHO) International Clinical Trials Registry Platform ( ) (24 May 2018), and reference lists of retrieved studies. Selection criteria All randomised controlled trials or cluster‐randomised trials comparing the effectiveness and side effects of uterotonic agents with other uterotonic agents, placebo or no treatment for preventing PPH were eligible for inclusion. Quasi‐randomised trials were excluded. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved. Data collection and analysis At least three review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for preventing PPH ≥ 500 mL and PPH ≥ 1000 mL as primary outcomes. Secondary outcomes included blood loss and related outcomes, morbidity outcomes, maternal well‐being and satisfaction and side effects. Primary outcomes were also reported for pre‐specified subgroups, stratifying by mode of birth, prior risk of PPH, healthcare setting, dosage, regimen and route of administration. We performed pairwise meta‐analyses and network meta‐analysis to determine the relative effects and rankings of all available agents. Main results The network meta‐analysis included 196 trials (135,559 women) involving seven uterotonic agents and placebo or no treatment, conducted across 53 countries (including high‐, middle‐ and low‐income countries). Most trials were performed in a hospital setting (187/196, 95.4%) with women undergoing a vaginal birth (71.5%, 140/196). Relative effects from the network meta‐analysis suggested that all agents were effective for preventing PPH ≥ 500 mL when compared with placebo or no treatment. The three highest ranked uterotonic agents for prevention of PPH ≥ 500 mL were ergometrine plus oxytocin combination, misoprostol plus oxytocin combination and carbetocin. There ...

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Impact of Preoperative Rectal Misoprostol on Blood Loss during and after Elective Cesarean Delivery: A Randomized Controlled Trial

Cited by 3 publications

References 0 publications

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

Carbetocin versus Misoprostol in Reducing Blood Loss during Cesarean Section in low risk patients. A Randomized Controlled Trial

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

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