Intérêt du misoprostol dans la prévention de l’hémorragie du post-partum immédiat en cas de césarienne : essai prospectif randomisé

Fékih, M.; Jnifene, A.; Fathallah, Khadija; Regaya, L. Ben; Memmi, A.; Bouguizène, S.; Chaïeb, A.; Bibi, M.; Khaïri, H.

doi:10.1016/j.jgyn.2009.09.006

Cited by 18 publications

(8 citation statements)

References 18 publications

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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%

“…One study met six criteria, 4 met five criteria and the remaining five met <5 criteria. Blood loss was measured using objective methods in ten studies 38,42,43,45,47-49,52-54 and clinical estimation in five studies, 39,40,46,50,51 unmeasured in one study 44 and unreported in another. 41 …”

Section: Resultsmentioning

confidence: 99%

“…46,48,50,53 Three of these studies were double masked and had a low risk of bias. 48,50,53 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 (MD, −2.1%; 95% CI, −3.4 to −0.8; P=0.001; three trials, 736 women; I 2 =91%) and use of additional uterotonic agents (11% vs 31%; RR, 0.33; 95% CI, 0.18 to 0.62; three trials, 660 women; I 2 =61%; NNT for benefit 5, 95% CI 4 to 9).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, one study reported a significant increase in the rate of abdominal pain, 53 and another showed an increase in the rate of any side effect. 46 One trial in which sublingual misoprostol was administered before delivery of the baby in women undergoing cesarean delivery under general anesthesia reported that Apgar scores at 1 and 5 min and neonatal cardiovascular status did not differ significantly between the study groups. 53 There were no significant differences between the groups in the risk of other outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Only seven trials included in our review were also included in the Cochrane review. 40-46 Data provided by these studies were pooled with data from studies that evaluated misoprostol in women after vaginal delivery. This review found that oral or sublingual misoprostol, compared with placebo, reduced significantly the risk of severe postpartum hemorrhage and blood transfusion.…”

Section: Commentmentioning

confidence: 99%

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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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