Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery

Abstract

Aim: With the increasing rate of cesarean delivery (CD) worldwide, there is a need for a revision of practices to prevent post-partum hemorrhage (PPH) after CD. In search of a safe, cheap and effective alternative to oxytocin for prevention of PPH during the postoperative period of CD, the present study aimed to compare rectally administrated misoprostol with i.v. oxytocin infusion.

Methods: A randomized, placebo-controlled, double-blind prospective trial was undertaken on 192 women who did not have risk factors for PPH and who had an uneventful emergency CD under spinal anesthesia. They were randomly allocated to receive either 800 mg of rectal misoprostol or an i.v. infusion of oxytocin at the end of operation. Primary outcome measures were the amount of postoperative (24 h) blood loss and incidence of PPH during the postoperative period. The secondary outcome measures were the postoperative drop in hemoglobin concentration after 24 h, need for additional uterotonic and blood transfusion, and side-effects/complications during the 24-h observation period.

Results: There was a significant reduction of blood loss in the misoprostol group compared with the oxytocin group (144.5 ± 100.1 vs 191.7 ± 117.1, P < 0.0001). The two groups were similar in terms of the secondary outcome parameters.

Conclusion: Rectally administrated 800-mg misoprostol may be an effective alternative to oxytocin infusion to prevent PPH after CD.

Keywords: cesarean delivery; misoprostol; oxytocin; post-partum hemorrhage; uterotonic.