Efficacy of Sublingual Misoprostol in Prevention of Postpartum Hemorrhage in Cesarean Section: A Randomized Double-blinded, Placebo-Controlled Trial

Abstract

Objectives : To determine efficacy of sublingual misoprostol in the reduction and prevention of postpartum blood loss in cesarean section. To determine the use of additional uterotonics and incidence of side effects.

Materials and methods : This was a randomized double-blinded, placebo-controlled trial. One hundred and twenty singleton pregnant women undergoing a cesarean delivery under spinal anesthesia were randomly divided into two equal groups (misoprostol (n = 60) or placebo (n = 60)) after the deliveries of babies and clamping of umbilical cords.

Results : The mean blood loss from the misoprostol group (615.67 ± 120.02 ml) was not significantly different from the control group (631.21 ± 157.63 ml) (p=.866). Only one patient in the control group had postpartum hemorrhage. Dropping in hemoglobin and hematocrit levels were not significantly different between the two groups. The need to give additional methergin therapy in the control group was significantly higher than the misoprostol group (23.3% vs 5.0% respectively, p = .004). However, the need to give additional nalador therapy was not significantly different between the two groups (10.0% in the control group vs 1.7% in the misoprostol group, p =.114). Incidence of shivering in misoprostol group was increased 1.57 fold compared with the control group (CI 1.15-2.14). Incidence of fever in misoprostol group was increased 9 fold compared with the control group (CI 1.18-68.85). There were no difference in incidence of nausea and vomiting between the two groups.

Conclusion : Misoprostol is an effective myometrial stimulant of the pregnant uterus. It can be used in addition to oxytocin to prevent postpartum hemorrhage. The advantages of misoprostol are its low cost, stability at room temperature, and no severe side effect.