COMPARISON BETWEEN 200, 400 AND 600 MICROGRAM RECTAL MISOPROSTOL BEFORE CAESARIAN SECTION TO REDUCE INTRA AND 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. 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. 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 efficacy of the rectal PGE1 synthetic analogue (misoprostol) 200, 400 and 600 microgram before cesarean section to decrease blood loss during and after the operation. In order to achieve this objective 453 women candidate for elective caesarian section were recruited, 1/3 of them received 200 microgram of misoprostol (Sigma) rectal and other 1/3 received 400 microgram misoprostol (Sigma) rectal and the last 1/3 received 600 microgram misoprostol (Sigma) rectal. 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.