EFFECT OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN ON REDUCING BLOOD LOSS AT CESAREAN SECTION

Rozhan Yassin Khalil a



Department of Gynecology and Obstetrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 
 

Submitted: 24/5/2019; Accepted: 29/10/2019; Published: 21/12/2019

ABSTRACT


Background 

Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent, has been reported to be useful in the prevention and treatment of postpartum hemorrhage by several investigators but its use during cesarean section has not been described.


Objectives 

To compare the effectiveness of sublingual misoprostol administered immediately after delivery of the neonate at cesarean section under spinal anesthesia, with intravenous oxytocin infusion in prevention of uterine atony and thereby reducing blood loss at cesarean section and prevention of postpartum hemorrhage.


Patients and Methods

This study is a prospective, comparative randomized study. One hundred women with singleton term pregnancy undergoing elective lower segment cesarean section under spinal anesthesia were included in this study, divided into two groups each group contains 50 cases, they were randomly allocated to receive either misoprostol 400 g sublingually or intravenous infusion of 20 units of oxytocin soon after delivery of the neonate. The main outcome measures were change in PCV percentage, the need for additional oxytocic and drug-related side effects are compared in both groups in this study.


Results

The PCV percentage which estimated was non significantly lower in the oxytocin group compared to the misoprostol group (32.3± 2.9 ml versus 33.1±3.2 ml; p-value = 0.23). There was a non-significant difference in mean of time of operation between two groups (33.7±5.2 in oxytocin group versus 33.8 ±3.9 in the misoprostol group, p-value=0.91). There was a need for additional oxytocic therapy in 4 cases (8%) in the oxytocin group which is lower than the misoprostol group which was 6 cases (12%). The incidence of side effects such as nausea lower in oxytocin group 2 cases (4%) vs 8 cases (16%) in misoprostol group, shivering and hyperthermia was lower in oxytocin group 1 case (2%) compared to misoprostol group 8 cases (16%) while hypotension was more in oxytocin group 6 cases (12%) vs 3 cases (6%) in misoprostol group.


Conclusions

Sublingual misoprostol was as effective as i.v. oxytocin infusion in reducing blood loss at cesarean section, and prevent postpartum hemorrhage, it offers several advantages over oxytocin, including long half-life, stability at room temperature, and oral administration, which make it a suitable uterotonic agent in low-resource areas The drug side effects were mild, transient, not life-threatening and self-limiting.



KEYWORDS

Cesarean section, Oxytocin, Sublingual misoprostol, Oxytocin infusion, Blood loss.