Intraoperative Blood Loss Reduction During Caesarean Delivery- Rectal Misoprostol Versus Oxytocin Infusion- A Randomized Controlled Trial
The first drug of choice recommended by the World Health Organization (WHO) for the prevention of primary postpartum haemorrhage during caesarean section is oxytocin. However, when oxytocin’s efficacy is questionable due to poor transportation, suboptimal storage and or adulteration as seen in developing countries, an adjunctive, synergistic and cheaper as well as temperature-stable, uterotonic such as misoprostol would be needed. The study was aimed at comparing the effectiveness of rectal misoprostol with that of oxytocin infusion in intraoperative blood loss reduction during caesarean section. The trial involved one hundred and forty pregnant women who had unequivocal indications for caesarean section and had risk factors for primary postpartum haemorrhage were randomized equally into two study groups, after informed consent. One study arm received adjunctive 40 IU of oxytocin infusion and the other arm received adjunctive 600 ug of rectally administered misoprostol, after clamping of the edges of the uterine wound with Green-Armytage forceps at caesarean section. The primary outcome measure was intraoperative blood during caesarean section. The statistical significance was set at p-value of 0.05. There was no statistically significant difference between the study groups in reduction of intraoperative blood loss during caesarean section (603.5 ± 153.8 ml vs 597.4 ± 200.9 ml, p= 0.839). It was concluded that rectally administered 600 ug misoprostol is an effective, non-inferior adjunctive uterotonic comparable to 40 IU oxytocin infusion in reducing intraoperative blood loss during caesarean section.
Adane D, Belay G, Arega A, Wassihun B, Gedefaw G, Gebayehu K. Practice and factors associated with active management of third stage of labour among obstetric care providers in Amhara region referral hospitals, North Ethiopia, 2018; 14(10):1. Available at https://doi.org/10.1371/journal.pone.0222843.
Gray C, Kenneth L, Steven B, Catherine S, et al. Obstetric Haemorrhage. In: Gray C, Kenneth L, Steven B, Catherine S, Jodi D, Barbara H, Brian C, Jeanne S, eds. Williams Textbook of Obstetrics, 24th edition. New York, USA: McGraw-Hill Education publishers; 2014: 780-820.
Fawole AO, Adegbola O, Adeyemi AS. Misoprostol for Induction of labour: a survey of attitude and practice in South Western Nigeria. Arch GynaecolObstet, 2008; 278(4):353-358.
Fawcus S, Moodley J. Postpartum haemorrhage associated with Caesarean section and Caesarean hysterectomy. Best Pract Res ClinObstetGynaecol, 2013; 27(2): 233-247.
Gizzo S, Patrelli TS, Gangi SD, Carrozzini M, Saccardi C, Zambon A, et al. Which uterotonics is better to prevent the postpartum haemorrhage? Latest news in terms of clinical efficacy, side effects and contraindications: a systemic review. Reprod Sci, 2013; 20(9): 1011-1019.
Weeks AD, Neilson JP. Rethinking our approach to postpartum haemorrhage and uterotonics. BMJ, 2015; 351-356.
Bischoff K, Nothacker M, Lehane C, et al. Lack of controlled studies in investigating the risk of postpartum haemorrhage in Caesarean delivery after prior use of oxytocin: a scoping review. BMC pregnancy and child and birth, 2017; 17:399-400.
Onyema OA. Cornelius A, Uchenna ET, Duke OA. Primary postpartum haemorrhage in Federal Medical Centre, Owerri, Nigeria: A six year review. Niger J Med, 2015; 24(3): 242-245.
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum haemorrhage in a large nationwide sample of deliveries. AnesthAnalg, 2010; 1101368-1101373.
Butwick AJ, Ramachandran B, Hedge P. Riley ET, El-Sayed Y, Nelson LM. Risk factors for severe postpartum haemorrhage after Caesarean delivery. Case control studies. AnesthAnalg, 2017; 125(2): 523-532.
Ajenifuja KO, Adepiti CA, Ogunniyi SO. Postpartum haemorrhage in a tertiary hospital in Nigeria: a 5 year experience. Afr Health Sci, 2010; 10(6): 71-74.
Oyelese Y, Anath CV. Epidemiology, risk factors and causes: ClinObstetGynecol, 2010; 23(1): 147-156.
Triopon G, Goron A, Agenor J, Aya GA, Chaillou AL, Begler-Fonnier J, Bousquet PJ. Use of Carbetocin in prevention of uterine atony during Caesarean section. Comparison with oxytocin. Gynaecologie, Obstetrique and fertilite, 2010; 38(12): 729 -734.
Elgafor el Sharkw IA. Carbetocin versus sublingual misoprostol plus oxytocin infusion for prevention of postpartum haemorrhage at Caesarean section in patients with risk factors: a randomized open trial study. Arch GynecolObstet, 2013; 288: 1231-1236.
Fredick M, Mercy F, Christopher P, Bi A, Lawrence M, Laura NA, Lehana T. Misoprostol as an adjunct to oxytocin can reduce primary postpartum haemorrhage: a propensity score-maternal retrospective chart review in Bamenda-Cameroon, 2015-2016. BMC Pregnancy child birth, 2019; 19:257-258.
Jeffrey F, Ndola P. Misoprostol for postpartum haemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC pregnancy and child birth, 2013; 13: 44-45. Available at: https://doi.org/10.1186/1471-2393-13-44. Accessed April 2, 2020.
WHO. Recommendation: Uterotonics for the prevention of postpartum haemorrhage. World Health Organization, Geneva: World Health Organization; 2018, 15-29.
Torloni MR, Gomes FC, Kartoglu UH, Metin GA, Winder M. Quality of oxytocin available in low-and-middle-income countries: a systematic review of the literature. BJOG.2016; 123(13):2076-2086.
Prevention and Management of Postpartum Haemorrhage. Green-top Guideline No. 52, RCOG (2015).
Islam M, Sathi NJ, Hossain MT, Jabbar A, Renzaho AMN, Islam SMS. Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa meta-analysis. Sci Rep 202;12:5554. Available: https://doi.org/10.1038/s41598-022-09567-1. Accessed June 29, 2022.
Allagoa DO, Oriji PC, Tekenah ES, Obagah L, Ohaeri OS, Mbah KM, et al. Caesarean section in a Tertiary Hospital in South-South, Nigeria: A 3 year Review. European Journal of Medical and Health Sciences; 2021, 3(2): 122-126.
Chaudhuri P, Mandi S, Mazumdar A. Rectally administered misoprostol as an alternative to intravenous oxytocin infusion after Caesarean delivery. J ObstetGynecol Res, 2014; 40(9): 2023-2029.
Schorn MN. Measurement of blood loss: Review of the literature. J Midwifery women’s Health, 2010; 55: 20-27.
AWHONN Practice Brief. Quantification of blood loss: AWHONN Practice Brief Number 1. JOG NN, 00, 2014: 1-3.
Adanikin AL, Orji E, Adanikan PO, Olaniyan O. Comparative study of rectal misoprostol to oxytocin infusion in preventing postpartum haemorrhage after Caesarean section. NJ OG 1, 2013; 8(2): 34-37.
Hua S. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Front Pharmacol. 2019;10:1196-1197.
Gungordrik K, Asicioglu O, Celikkol O, Oglac Y, Ark C. Use of additional oxytocin to reduce blood loss at elective Caesarean section: A randomized controlled trial. Australian and New Zealand journal of Obstetrics and Gynaecology. 2010;50 (1):36-39.
Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogon RG, Gleeson R, et al. Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective Caesarean section: double blind, placebo controlled, randomized trial. BMJ 2011; 343-344.
Postpartum Hemorrhage. ACOG Practice Bulletin Vol. 130, No. 18, Clinical Management Guidelines for Obstetrician-Gynaecologists (2017).
Andrew B, Nina H, Charlotte G, Gil M. Postpartum Haemorrhage. In: Andrew B, Nina H, Charlotte G, Gil M, eds. Oxford Handbook of Clinical Specialties 10th edition, UK: Oxford University Press; 2016: 84-85.
Chaundari P, Banerjee GB, Mandal A. Rectally administered misoprostol versus intravenouis oxytocin infusion during Caesarean delivery to reduce intra- and post-operative blood loss. Int J GynaecolObstet, 2010; 109(1):25-29.
Fazel MR, Mansoure –Samimi, Esmaeil-Fakharian. A comparison of rectal misoprostol and intravenous oxytocin on haemorrhage and homeostatic changes during caesarean section. Middle East J Anaesthesiol. 2013; 22(1):41-46.
Aworinde OO, Olufemi-Aworinde KJ, Ogunlaja OA, Olutogun TA, Akinola SE, Adeyemi AS. Optimal Timing of Post-operative haematocrit check in obstetric and Gynaecological surgeries. Res J Health Sci. 2018;6(1):35-42.
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Copyright (c) 2022 Ebiogbo S. Ozori, Ibrahim A. Isa, Oyeyemi Nuvie, Peter W. Oweisi, Zawua Zakaa, Alabintei M. Ochuko, Abuchi L. Okpara, Peter I. Ogidigba
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