Is the Time of administration of misoprostol of value? The uterotonic effect of misoprostol given pre- and post-operative after elective cesarean section

• Published in: Middle East Fertility Society journal Vol. 19; no. 1; pp. 8 - 12
• Main Authors: Abd-Ellah, Ahmed H., Tamam, Abdel Aziz E., Khodry, Mostafa Mohammed
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.03.2014; SpringerOpen
• Subjects: Blood loss; Cesarean section; Misoprostol; Post-operative; Pre-operative; Uterotonic drugs; Post-operative; Uterotonic drugs; Misoprostol; Pre-operative; Cesarean section; Blood loss
• ISSN: 1110-5690
• DOI: 10.1016/j.mefs.2013.09.002

The aim of the current study was to compare blood loss in pre- and post-operatively rectally administered 600μg of misoprostol in elective cesarean delivery, in order to determine the optimal time for drug administration (CS). A 30-month prospective, single-blind, randomized, clinical trial was done in the Qena University Hospital, Egypt, from January 2010 to October, 2012. Intervention consisted of pre and post-operative rectally administered misoprostol. At baseline, there were no significant differences in the demographic and obstetric variable between groups. Primary outcome measures were differences in intra-operative and postoperative blood loss between groups. Secondary outcomes measures were hemoglobin levels pre and operative (24h after CS) and the need for additional uterotonic drugs. A total of 300 subjects were enrolled (pre-operative administrated rectally misoprostol n=150, post-operative administrated rectally misoprostol n=150). Subjects receiving pre-operative misoprostol achieved significantly lower blood loss compared to those receiving post-operative misoprostol (620±291ml vs. 898±321ml, p<0.05), respectively. The need for additional uterotonic was significantly higher in subjects receiving post-operative misoprostol compared to those receiving pre-operative misoprostol (53.3% vs. 30%, p, 0.05), respectively. Pre-operative rectally administrated misoprostol appears to be more effective than post-operative rectally administrated misoprostol in reducing blood loss, and in decreasing the need for other uterotonic drugs in cesarean section delivery.