COMPARISON BETWEEN RECTAL & SUBLINGUAL MISOPROSTOL "400 MICROGRAM" BEFORE CAESARIAN SECTION TO REDUCE INTRA & POST-OPERATIVE BLOOD LOSS

Abstract

P ostpartum hemorrhage continues to be the leading cause of maternal morbidity and mortality worldwide according to estimate of the World Health Organization in 2008. Average blood loss during delivery progressively increases with mode of delivery; vaginal delivery (500 ml), cesarean section (1000 ml) and emergency hysterectomy (3500 ml) of blood (Chaudhuri et al., 2010). Excessive blood loss as estimated by a 10% drop in hematocrit post delivery or by need for blood transfusion occurs in approximately 4% of vaginal deliveries and 6% of cesarean births (Combs et al., 1991). A reduction of operative blood loss at cesarean section is beneficial to the patients in terms of decreased post operative morbidity and a decrease in risks associated with blood transfusion. The routine use of oxytocin is associated with a significant reduction in the occurrence of post partum hemorrhage. Misoprostol is an easy alternative to be used for the prevention of post partum hemorrhage being used via multiple routes and is heat stable and also inexpensive; hence comes its importance in preventing post partum hemorrhage. The main objective of this study was to evaluate and compare the effectiveness of rectally administered versus sublingually administered misoprostol (PGE1 synthetic analogue) 400 micrograms before caesarean section to decrease blood loss during and after the operation. In order to achieve this objective 636 women candidate for elective caesarian section were recruited, 1/3 of them received 400 microgram of misoprostol (Sigma) rectal and other 1/3 received 400 microgram misoprostol (Sigma) sublingual and the last 1/3 (control group) received placebo. All women participated in the study were examined before joining to find any of the exclusion criteria, had their pulse, blood pressure and temperature measured with general examination and history was taken from them all. The primary outcomes were the difference between the 2 groups in the estimated blood loss and change in hemoglobin and hematocrit values while the secondary outcomes were the need for additional oxytocin therapy, the apgar score of the fetus at 1 and 5 minutes, operative time, the need for blood transfusion and extra analgesics, post operative side effects mainly fever and shivering and any significant puerperal morbidity, e.g. wound sepsis.