The effect of intrauterine misoprostol on blood loss during caesarean section

Abstract

Excessive bleeding during and after caesarean section is a major cause of maternal morbidity and mortality, especially in low resource countries. This study evaluates the effect of intrauterine misoprostol with oxytocin in comparison with oxytocin alone on blood loss during caesarean section. A retrospective data analysis of 160 women who underwent lower segment caesarean section was conducted. Eighty-five out of 160 (53%) women received tablet misoprostol 800 µg by intrauterine route after delivery of a baby in addition to routine oxytocin infusion (group A), while 75 women (47%) received only oxytocin (group B). Blood loss, Haemoglobin (Hb) difference (pre-operative Hb – post-operative Hb) and need of any other oxytocic were compared in both the groups. Demographic variables such as mean age, parity, and an indication of caesarean section were comparable in both the groups. Mean blood loss during caesarean section was lower in group A (680 ± 202 mL) than group B (740 ± 228 mL) (p = .08). Higher Hb difference was noted in group B (1.03 ± 0.83 gm%) than group A (0.93 ± 0.68 gm%) (p = .41). No patient required additional oxytocic and no patient had postpartum haemorrhage in both the groups. The use of misoprostol by the intrauterine route in addition to routine oxytocin infusion during caesarean section is associated with a clinically significant reduction in intra-operative and post-operative blood loss.IMPACT STATEMENTWhat is already known on this subject? The role of misoprostol in the prevention and treatment of haemorrhage during and after caesarean section is well known and well studied. It is a better alternative to oxytocin in low resource settings. Various routes of misoprostol, with or without oxytocin, and its effect on intrapartum and postpartum haemorrhage are described in the literature. Misoprostol is an autocoid substance and acts better if it is close to the target organ (uterus). The use of misoprostol by the intrauterine route during caesarean section has not been well explored.What do the results of this study add? The use of misoprostol by intrauterine route in addition to routine oxytocin infusion during caesarean section is associated with decreased intra-operative and post-operative -blood loss.What are the implications of these findings for clinical practice and/or further research? The findings of this study reveal that misoprostol is also effective by the intrauterine route. It is a convenient way to insert misoprostol during caesarean section and it can be considered to prevent intrapartum and postpartum haemorrhage. More studies including randomised controlled trials with bigger sample size are needed to reach to any firm conclusion.