Preoperative Versus Postoperative Misoprostol in Elective Cesarean Section to Reduce Blood Loss A double-blinded Randomized Clinical Trial

Abstract

Postpartum 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). 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 postpartum hemorrhage. Misoprostol is an easy alternative to be used for the prevention of postpartum hemorrhage being used via multiple routes and is heat stable and also inexpensive; hence comes its importance in preventing postpartum hemorrhage. The main objective of this study was to evaluate and compare the effectiveness of sublingually administered misoprostol (PGE1 synthetic analogue) 400 micrograms before and after caesarean section to decrease blood loss during and after the operation. In order to achieve this objective 240 women candidate for elective cesarean section were recruited, 1/2 of them received sublingual 400 microgram of misoprostol (Sigma) preoperative and other 1/2 received 400 microgram misoprostol (Sigma) postoperative.