The Effect of Misoprostol Given Preoperative Versus Postoperative on Blood Loss with Elective Cesarean Section: Randomized Controlled Trial (RCT)

Abstract

Cesarean section is one of the most common operation performed on women worldwide and its rates steadily rise in both developed and developing countries. Its incidence 20% to 30% worldwide and increasing despite the recommendation of WHO to decrease it below 10 %. In developed countries it is associated with the increase in CS rate, postpartum hemorrhage is considered the leading cause of death in most developing low income countries .loss of more than 1000ml blood after CS is considered postpartum hemorrhage . Misoprostol is a prostaglandin E1 analoue and has selective uterotonic activity by binding to E series prostanoid receptors. Being inexpensive, stable, slower absorbed and rectally administered with low side effects by rectal route, makes it most commonly used to control PPH. Most of studies have reported the effectiveness of misoprostol for management and control of PPH. This was prospective, randomized trial study the effect of misoprostol on blood loss during and after elective cesarean delivery. A total 140 pregnant women were recruited in this study and divided and randomized into 2 groups each group 70 cases who received misoprostol .group 1 received the drug before cesarean section and group 2 received the drug after Cesarean section . Misoprostol was administered rectally after catheterization and before skin incision to group 1 and after operation to group 2. Preoperative hemoglobin and hematocrit value was measured before and after C.S for all cases. Assessment of blood loss during operation started by collection of blood loss in separate suction bottle and amniotic fluid in another suction and by weighting of soaked towels. Postoperative blood loss was measured during the first 24 hour every 6 hour by weighting the pads. We also recorded the side effects and compared in both groups and results were compared in both groups. Results of current study showed that: In this study as regard to demographic data there was a statistically insignificant difference between group 1 and group 2 as regard Age, gestational age by date, gestational age by U/S and Weight (P>0.05) In addition there was a statistically insignificant difference between group1 and group 2 as regard to mean arterial blood pressure, Systolic blood pressure Preoperative, diastolic blood pressure Preoperative, Systolic blood pressure Postoperative and diastolic blood pressure Postoperative (P>0.05). The mean HB Preoperative was (10.65 + 0.64) in group 1 while it was (10.58 + 0.60) in group 2. HB Postoperative was (9.52 + 0.66) in group 1 while it was (8.86 + 0.58) in group 2. The mean HCT Preoperative was (34.46 + 1.40) in group 1 while it was (34.41 + 1.31) in group 2. HCT Postoperative was (31.24 + 1.56) in group 1 while it was (29.37 + 1.84) in group 2. There was a statistically insignificant difference between the 2 studied groups as regard HB Preoperative and HCT Preoperative (P>0.05). However; there was a highly statistically significant difference between the 2 studied groups as regard HB Postoperative and HCT Postoperative (P<0.01). As regard HB Difference (mg %) it was (1.14+26) in group 1 while it was (1.72+.31) in group 2 . as regards to hematocrit value difference it was ( 3.21+.80)in group 1 while it was (5.04+.91 )in group 2 and there was a highly statistically significant difference between the 2 studied groups as regard HB Difference and HCT Difference (P<0.01).