EFFECTS OF SUBLINGUAL MISOPROSTOL VERSUS OXYTOCIN INFUSION ON BLOOD LOSS AT CAESAREAN SECTION

Abstract

OBJECTIVES:
To compare the effectiveness of sublingual Misoprostol administered immediately after delivery of the baby at caesarean section with intravenous Oxytocin infusion in producing uterine tonicity and thereby reducing blood loss at caesarean section, and to compare the accuracy in estimating blood loss at caesarean section by the Anaesthetists and the Obstetricians.

METHODOLOGY:

The study is a prospective randomised study involving one hundred women with singleton term pregnancy undergoing elective or emergency lower segment caesarean section under spinal anesthesia. They were randomly allocated to receive either Misoprostol (cytotec ® tablet, Searle & Co. Chicago) 400microgram (μg) sublingually or intravenous infusion of 20 units of Oxytocin (Rotexmedica, Trittau, Germany) soon after delivery of the baby. The main outcome measures were blood loss at caesarean section estimated by both the Anaesthetist and the Obstetricians, the pre and post operative packed cell volume, need for additional oxytocics and drug side effects.

RESULTS:

There were no significant difference in mean blood loss in both Oxytocin and Misoprostol groups as estimated by the Anaesthetist and the Obstetricans. Similarly no significant difference was found in both groups when the blood loss was calculated using the post operative packed cell volume. There was a need for additional Oxytocin in 42% and 48% after initial use of Oxytocin and Misoprostolrespectively but the difference was not significant (p = 0.439). The incidence of side effect like shivering was significantly more in Misoprostol group compared to Oxytocin group (P< 0.05). Visual blood loss estimation was found to be grossly inaccurate as there was a statistically significant difference between estimated blood loss and calculated blood loss (P< 0.05). The Anaesthetists were found to be more accurate blood loss estimators than the Obstetricians who tend to under estimate blood loss at delivery.

CONCLUSION:

Sublingual Misoprostol appears to be as effective as intravenous infusion of Oxytocin in reducing blood loss at caesarean section. It offers several advantages over Oxytocin such as long shelf life, stability at room temperature and oral administration which make it a safe and suitable uterotonic agent in low resource tropical countries.

EFFECTS OF SUBLINGUAL MISOPROSTOL VERSUS OXYTOCIN INFUSION ON BLOOD LOSS AT CAESAREAN SECTION