A Comparative Study Of Rectal Misoprostol Versus Intravenous Oxytocin In Reducing Intra And Postoperative Bleeding During Elective Cesarean Section

Abstract

Background and Objectives : To Compare the efficacy and safety of 400mcg misoprostol per rectum preoperatively versus intravenous oxytocin in reducing intra operative and post operative bleeding in elective caesarean section. Methods : The following study included 300 women who was admitted in Department of obstetrics and gynaecology, _______________ as elective cases for cesarean section .Detailed history of all the patients were taken according to the performa and complete examination and all necessary investigations were done. After having met all the inclusion and exclusion criteria and obtaining written consent. The study will include two groups.Group (A) MISOPROSTOL Group-150: women taken up for cesarean section were given preoperatively tablet misoprostol 400 microgram per rectal after spinal anesthesia before painting and draping was done. Group (B) –OXYTOCIN Group -150: women were given intravenous inj. oxytocin 10 IU in 500ml RL after extraction of baby in cesarean section. Results : The age varied from ≤20 years to >25 years. Most common age group was 21-25 years constituted total 185 (61.7%) patients. The mean age of Misoprostol and Oxytocin group was 22.88 and 22.92 years respectively. In the present study we observed the number of multiparous women were higher than primiparous women. Multipaous and primiparous women were 54.7% and 45.3% respectively in Misoprostol group; 64% and 36% in Oxytocin group. The commonest side effect of Misoprostol in the study subjects was shivering accounts for 22% (33) patientsfollowed by fever constituted for 6% (9) patients. In Oxytocin group nausea and vomiting was observed as side effects constituted 8% patients each. While analyzing for side effects we found a highly significant difference in two groups. Conclusion : The above results indicate that in the context of active management of 3rd stage of labour, Misoprostol has comparable effectiveness to oxytocin (10 IU IV in 500 ml RL) in the prevention of early postpartum haemorrhage. However, misoprostol was associated with higher incidence of shivering and pyrexia but no other serious adverse effects occurred. Hence, rectal misoprostol can be safely used in low risk caesarean deliveries as an alternative to 10 IU oxytocin in AMTSL. It should be included as an alternative in delivery protocols and also added to the list of essential drugs for affordable access. In future it may be an important and effective option for the management of third stage labour particularly in women where oxytocin is contraindicated.