Comparison between Adjunctive Sublingual Misoprostol Versus Oxytocin Alone in the Reduction of Intraoperative Blood Loss during Caesarean Section

Abstract

Background: The use of oxytocin in tropical developing countries for the reduction blood loss at caesarean section is being met with the challenge of ineffectiveness. This is due to poor transportation, and inadequate storage. Therefore, there is a need for an effective, temperature stable, adjunctive uterotonic such as misoprostol. Methodology: The study aimed at evaluating the effectiveness of adjunctive sublingual misoprostol in reducing intraoperative blood loss at caesarean section. One hundred and fifty-two pregnant women at term who had indications for caesarean section and have risk factors for primary postpartum haemorrhage were randomized equally into the Misoprostol-oxytocin study arm and Placebo-oxytocin study arm. The Misoprostol-oxytocin study group received 400-ug of sublingual misoprostol. Both study arms received 30 IU intravenous oxytocin. The main outcome measure was the estimated intraoperative blood loss. A P-value < .05 was considered statistically significant. Results: The blood loss at abdominal birth, was lower in the misoprostol-oxytocin study group when compared to the placebo-oxytocin study group (664.0 ± 285.2 ml vs 677.9 ± 430.3 ml), but this was not statistically significant (P = .80). The reduction in the packed cell volume after caesarean birth in the misoprostol-oxytocin trial arm of the study was lesser than that obtained in the placebo-oxytocin study group. This was also not statistically significant, (3.8± 2.9 vs 4.4 ± 3.1, P = .18). Conclusion: Sublingually administered adjunctive misoprostol at a dose of 400 ug did not considerably reduce caesarean section bleeding. It also did not appreciably lessen the drop in postoperative packed cell volume. However, it still has a place in reducing blood loss following caesarean birth in parturients with additional risk factors for postpartum haemorrhage.