Uterotonic effect of rectal misoprostol as preoperative medication for assessment of intraoperative and postoperative blood loss in cesarean delivery

Authors

  • Urmila Karya Department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, Uttar Pradesh, India
  • Shweta Maheshwari Department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, Uttar Pradesh, India
  • Anupam Rani Department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20211113

Keywords:

Misoprostol, Preoperative medication, Caesarean delivery, Postpartum hemorrhage

Abstract

Background: Postpartum hemorrhage is the leading cause of maternal mortality and it's prevention has been identified as key component of safe motherhood. Misoprostol is an effective uterotonic for prophylaxis and control of PPH. Aim of our study was to evaluate the effect of preoperative rectal misoprostol (400μg) on blood loss during and after cesarean delivery.

Methods: It was a randomised controlled trial done on 200 women scheduled for elective cesarean delivery. Eligible participants were randomized into two groups. In the study group 100 women received a preoperative 400 μg per rectal misoprostol tablet just after spinal anaesthesia while 100 women assigned to the control group did not receive misoprostol tablet.

Results: The mean intra operative and postoperative blood loss was lower in study group than the control group 345.98±79.57 ml and 114±19.97 ml versus 408.6±63.68 ml and 136.38±24.81 ml, respectively. The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (33.43±1.93 and 33.64±1.82)

Conclusions: In our study it was concluded that preoperative 400 μg rectal misoprostol is effective in reducing intraoperative and postoperative blood loss, thus preventing postpartum hemorrhage and reducing incidence of overall maternal morbidity and mortality.

References

WHO maternal mortality Fact sheet Updated November 2016. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Last accessed on 14 October, 2019.

Postpartum hemorrhage - World Health Organization. https://www.who.int/medicines/areas/priority_medicines/Ch6_16PPH.pdf. Last accessed on 14 October, 2019.

Theresa A. Lawrie, Ewelina Rogozińska, Pauline Sobiesuo, Joshua P. Vogel, Laura Ternent , Olufemi T. Oladapo A systematic review of the cost‐effectiveness of uterotonic agents for the prevention of postpartum hemorrhage Int J Gynecol Obstet. 2019

Bajwa SK, Bajwa SJS, Kaur H, Goraya SPS, Singh A et al. Management of third stage of labor with misoprostol: A comparison of three routes of administration Perspect Clin Res. 2012;3(3):102-8.

Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018;4:CD011689.

Udayan MA, Hareshbhai PP. A Study on efficacy and safety of the drug misoprostol 600 mcg for prevention of postpartum hemorrhage by different routes of administration in routine management of 3 stage of labor; a randomized placebo controlled double blind study. I.M.A.G.S.B. NEWS BULLETIN / AUGUST – 2014;9(8). imagsb.com/uploads/bulletin/August-2014.pdf. Accessed on 14 October, 2019

Goldberg AB, Greenberg MB, Darney PD. Misoprostol and Pregnancy January 4, 2001 N Engl J Med. 2001;344:38-47.

Tang O, Gemzell-Danielsson K, H PC. Misoprostol: Pharmokinetic profiles, effects on the uterus and side-effects International Journal of Gynecology and Obstetrics. 2007;99:S160-S167.

Mirteimouri, Tara M, Teimouri F, Sakhavar B, Vaezi N, Afsaneh. Efficacy of Rectal Misoprostol for Prevention of Postpartum Hemorrhage. Iranian journal of pharmaceutical research: IJPR. 2019;12;469-74.

Rehan K, El-Refaey, Hazem. Pharmacokinetics and Adverse-Effect Profile of Rectally Administered Misoprostol in the Third Stage of Labor. Obstetrics and gynecology. 2003;101:968-74.

Kumari A, Swathi E, Saranu S. Impact of pre-operative 200 µg (P/R) per rectal misoprostol on blood loss during and after Cesarean delivery. IAIM. 2016;3(6):49-58.

Sood, A.K., Singh, S. Sublingual Misoprostol to Reduce Blood Loss at Cesarean Delivery. J Obstet Gynecol India. 2012;62:162-167.

Sarita S, Uprety DK Achala T, Tarun P. Impact of Preoperative Rectal Misoprostol on Blood Loss during and after Elective Cesarean Delivery: A Randomized Controlled Trial. Nepal Journal of Obstetrics and Gynaecology. 2017;11:37.

Mervat SEA. Elsedeek. Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery. International Journal of Gynecology & Obstetrics. 2012;118(2):14-9152.

Ellah A, Tamam A, Khodry A, Mostafa. Is the Time of administration of misoprostol of value? The uterotonic effect of misoprostol given pre- and post-operative after elective cesarean section. Middle East Fertility Society J. 2013;19:10.

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Published

2021-03-24

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Original Research Articles