Intrauterine Misoprostol plus Intravenous Oxytocin for Reduction of Blood Loss in Cesarean Delivery

Abstract

Objectives: To evaluate the efficacy of using intrauterine misoprostol combined with oxytocin intravenous infusion to reduce intraoperative blood loss and prevent postpartum hemorrhage in cesarean section.Materials and Methods: Efficiency research, randomized control trial in 222 term pregnant women who admitted for cesarean section in any indications as defined at Phayao hospital between October 1, 2016 and December 31, 2016. All pregnant women received 20 units of oxytocin by intravenous infusion immediately after delivery of the baby. Eight hundred micrograms misoprostol were inserted at both sides of uterine cornu after placental delivery in treatment group by random assignment. The treatment outcomes were measured by volume of intraoperative blood loss, preoperative and postoperative hemoglobin and hematocrit levels, requirements for additional uterotonic drugs and side effects related to misoprostol.Results: Intrauterine misoprostol combined with oxytocin intravenous significantly reduced the estimated intraoperative blood loss when compared with oxytocin intravenous only (418.5 ± 153.0 ml vs 647.4 ± 244.8 ml, p < 0.001). Also reduction of the total blood loss within 24 hours postoperative which was measured by the difference of hemoglobin/hematocrit levels preoperatively and postoperatively (0.9 g/dl (0.3-1.4) vs 1 g/dl (0.4-1.8), p = 0.032 and 2.4%(1.1-4.2) vs 3.0%(1.4-5.6), p = 0.024 respectively). Furthermore additional uterotonic drug requirements (2.7% vs 9.0%, p = 0.041) and operative time also decreased (24.2 ± 8.4 mins vs 27.1 ± 12.5 mins, p = 0.046). However, maternal fever was detected within 24 hours postoperative (≥ 38oC) (66.7% vs v38.7%, p < 0.001).Conclusion: Intrauterine misoprostol combined with oxytocin infusion during cesarean section could reduce intraoperative blood loss, prevent postpartum hemorrhage and reduce any additional uterotonic drug requirements. A minor side effect such as fever was identified which subsided spontaneously within 24 hours.

Keywords

• intrauterine misoprostol
• intraoperative estimated blood loss
• cesarean section
• postpartum hemorrhage