EFFECT OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN ON REDUCING BLOOD LOSS AT CESAREAN SECTION
Keywords:Cesarean section, Oxytocin, Sublingual misoprostol, Oxytocin infusion, Blood loss
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.
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.
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.
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.
Edmonds K. Dewhurst’s Textbook of Obstetrics and Gynaecology: Wiley; 2011.
Baker PN, Kenny L. Obstetrics by ten teachers: CRC Press; 2011. 234-8 p.
Luesley DM, Baker PN. Obstetrics and Gynaecology: An Evidence-based Text for MRCOG: Hodder Arnold; 2010. 402-9 p.
Cunningham F, Leveno KJ, Bloom SL, Hauth JC, Rouse D, Spong C. Obstetrical anesthesia. 23 ed. New York: McGraw-Hill; 2010. 549-55 p.
Baker PN, Kenny L. Obstetrics by ten teachers. 19 ed: CRC Press; 2011. 241-8 p.
Tsu V, Langer A, Aldrich T. Postpartum hemorrhage in developing countries: is the public health community using the right tools? International journal of gynecology & obstetrics. 2004;85:S42-S51.
Cunningham F, Leveno KJ, Bloom SL, Hauth JC, Rouse D, Spong C. Obstetrical anesthesia. 23 ed. McGraw-Hill: New York; 2010. 35 p.
Baskett T. Complications of the third stage of labour. Essential Management of Obstetrical Emergencies. 1999;3:196-201.
Baker P, Johnson I, Jones G, Kean L, Kenny L, Mires G. Obstetric emergencies. 18 ed. London: Hodder Arnold; 2006. 220-54 p.
Ayyad I, Omar A. Prevention of postpartum hemorrhage by rectal misoprostol: A randomized controlled trial. Middle East Journal of Family Medicine. 2004;5(5).
Waterstone M, Murphy JD, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control studyCommentary: Obstetric morbidity data and the need to evaluate thromboembolic disease. BMJ. 2001;322(7294):1089-94.
Senior J, Marshall K, Sangha R, Clayton J. In vitro characterization of prostanoid receptors in human myometrium at term pregnancy. Br J Pharmacol. 1993;108(2):501-6.
Campbell S, Lee C. Obstetrics by ten teachers 17 ed. London UK: Arnold publisher; 2000. 117 p.
Norwitz ER, Schorge JO. Obstetrics and Gynaecology at a Glance 1st ed: Wiley; 2001.
Prendiville WJ, Elbourne D, McDonald SJ. Active versus expectant management in the third stage of labour. Cochrane database of systematic reviews. 2000(3).
Edmonds K. Dewhurst’s Textbook of Obstetrics and Gynaecology: Wiley; 2007.
Drife J. Management of primary postpartum hemorrhage. BJOG. 1997;104(3):275-7.
Hayman R. Induction of labour. 1st ed. London: Arnold; 2004. 327-34 p.
Ellsworth A, Witt D, Dugdale D. Mosby’s Medical drug reference, 1999-2000. Inc., St. Louis: Mosby and Co; 2000. p. 609.
Tenore JL. Methods for cervical ripening and induction of labor. Am Fam Physician. 2003;67(10):2123-8.
Carlan S, Blust D, O’Brien WF. Buccal versus intravaginal misoprostol administration for cervical ripening. Am J Obstet Gynecol. 2002;186(2):229-33.
Carmichael MS, Humbert R, Dixen J, Palmisano G, Greenleaf W, Davidson JM. Plasma oxytocin increases in the human sexual response. The Journal of Clinical Endocrinology & Metabolism. 1987;64(1):27-31.
Machin GA, Ackerman J, Gilbert-Barness E. Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol. 2000;3(5):462-71.
Drife JO, Magowan B, Ramsden I. Clinical obstetrics and gynecology. 1st ed. London, United Kingdom: Elsevier Health Sciences; 2004. 415-8 p.
Chanrachakul B, Herabutya Y, Punyavachira P. Randomized comparison of glyceryl trinitrate and prostaglandin E2 for cervical ripening at term. Obstet Gynecol. 2000;96(4):549-53.
Carpenter CC, Griggs R, Loscalzo J. Cecil essentials of medicine. 5 ed. United States: W.B. Saunders Company; 2001. 339-40 p.
Jiranek G, Kimmey M, Saunders D, Willson R, Shanahan W, Silverstein F. Misoprostol reduces gastroduodenal injury from one week of aspirin: an endoscopic study. Gastroenterology. 1989;96(2):656-61.
Zurich DB. Physicians’ desk reference. 47th ed. US: Medical Economics Data; 1993.
Tang OS, Schweer H, Seyberth H, Lee SW, Ho PC. Pharmacokinetics of different routes of administration of misoprostol. Hum Reprod. 2002;17(2):332-6.
Blanchard K, Clark S, Winikoff B, Gaines G, Kabani G, Shannon C. Misoprostol for women’s health: a review. Obstet Gynecol. 2002;99(2):316-32.
Clark S, Blum J, Blanchard K, Galvao L, Fletcher H, Winikoff B. Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States. International Journal of Gynecology & Obstetrics. 2002;76(1):65-74.
Lapaire O, Schneider M, Stotz M, Surbek D, Holzgreve W, Hoesli I. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. International Journal of Gynecology & Obstetrics. 2006;95(1):2-7.
Acharya G, Al-Sammarai MT, Patel N, Al-Habib A, Kiserud T. A randomized, controlled trial comparing the effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section. Acta Obstet Gynecol Scand. 2001;80(3):245-.
Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section. International Journal of Gynecology & Obstetrics. 2006;92(2):106-10.
Copyright (c) 2019 Rozhan Yassin Khalil
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.