A COMPARISON OF THE EFFECTIVENESS OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN INFUSION IN REDUCING BLOOD LOSS IN FIRST TWO HOURS AT CAESAREAN SECTION

Abstract

OBJECTIVE

The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing intraoperative and postoperative blood loss with that of intravenous (IV) oxytocin infusion in the first two hours at cesarean delivery.

STUDY DESIGN

Randomized controlled trial

PLACE AND DURATION OF STUDY

The study was conducted in Lady Aitchison Hospital, Lahore unit IV-King Edward Medical University, and the duration of the study was one year.

MATERIALS and METHODS

Eighty-two women with term singleton pregnancy undergone elective cesarean section under spinal anesthesia were randomly allocated to receive either misoprostol 400 µg sublingually or  IV infusion of 20 units oxytocin in 1000ml of normal saline soon after delivery of the baby. Estimated blood loss at the surgery and within the first 2 h post-operation were measured in both groups. Side effects in both groups were also recorded.

RESULTS

Mean blood loss with misoprostol was significantly less as compared to that of oxytocin. Post-operative hemoglobin was decreased by -4.95% in sublingual misoprostol and in the oxytocin group it was decreased by -9.33%. Blood transfusion and additional uterotonic therapy were significantly higher in the oxytocin group as compared to that of misoprostol. Nausea, vomiting, and hypotension was significantly higher in oxytocin group as compared to that of the misoprostol group. On the other hand, pyrexia and shivering were significantly higher in the misoprostol group.

CONCLUSION

The results of this trial showed that sublingual misoprostol is more effective as compared to intravenous oxytocin infusion in terms of reduction of blood loss in the first two hours at the cesarean section. It offers several advantages over oxytocin including long shelf life, stability at room temperature, and oral administration which makes it a suitable uterotonic agent in low-resource areas.