Comparison between using intrauterine misoprostol with oxytocin infusion and oxytocin alone in reduction of blood loss in cesarean delivery

Abstract

Background Postpartum hemorrhage is an unexpected obstetricity and one of the five major causes of death among women in both developed and nondeveloped countries. Many women over 20 weeks of pregnancy are at risk of experiencing postpartum hemorrhage and its consequences. Objective To compare the effectiveness of the combination of intrauterine misoprostol and oxytocin infusion and oxytocin infusion alone in decreasing blood loss at cesarean delivery. Patients and methods The study participants were selected randomly, and a trial was carried out at Al-Zahraa University Hospital in the period between May 2019 to January 2020. A total of 200 pregnant women referred to the cesarean section (CS) were divided randomly into two study groups: group I received 800 μg of misoprostol intrauterine after delivery of placenta, which was inserted at cornual part bilaterally, 400 μg in each group combined with 20 U of oxytocin infusion after delivery of the fetus. Group II was given 20 U of oxytocin infusion after delivery of the fetus. Blood loss during CS was measured. Hemoglobin and hematocrit values were measured preoperatively and 24 h postoperatively. Results Intrauterine misoprostol mixed with oxytocin infusion led to a substantial decrease in the intraoperative blood loss in comparison with oxytocin alone (561.42±113.33 vs. 653.60±149.52 ml) (P=0.001). In addition to that, there was a reduction that was statistically significant in the median differences of hemoglobin [1.20 g/dl (0.70–1.5) vs. 1.7 g/dl (1.3–2.2)] (P=0.001) and hematocrit [1.40% (1.1–1.2) vs. 4.5% (3–6.1)] (P=0.001) values when measured before and 24 h after CS. The need for additional uterotonics was highly decreased in the study group (5%) compared with the control group (16%). There was no significant difference in the incidence of adverse effects of misoprostol between the two groups. Conclusion The use of 800 µg intrauterine misoprostol combined with oxytocin infusion in CS can significantly reduce blood loss, preserve hemoglobin and hematocrit, and decrease the need for additional uterotonics without significant adverse effects when compared with oxytocin infusion alone.