COMPARISON OF PREOPERATIVE MISOPROSTOL VERSUS STANDARD ACTIVE MANAGEMENT IN MINIMIZING BLOOD LOSS DURING ELECTIVE CAESAREAN SECTION
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Keywords
Misoprostol, oxytocin, AMTSL, hemorrhage
Abstract
Background: Blood loss in the third stage of labour can be fatal if massive postpartum hemorrhage occurs during or after a delivery. In practice most of the patients have been found to develop hemorrhage immediately after delivery till the discharge of placenta, a period known as third stage of labour. Preventive measures are routinely practiced to minify the chances of post-partum hemorrhage.
Objective: A study was conducted to analyse the effect of pre-operative rectal misoprostol in addition to active management of third stage of labour in minimizing blood loss within 24 hours after elective caesarean delivery.
Material and Methods: This randomized control trial was conducted in MCH center, PIMS, Islamabad after taking clearance from ethical committee from January 2019 to june 2019. A total of 126 patients were randomly allocated to either of two groups. Group A, who received a combination of rectal misoprostol + active management of third stage of labour (n=63) or Group B, who received active management of third stage of labour alone (n=63). Women with uncomplicated singleton pregnancy, having gestational age of >37 completed weeks who were undergoing elective cesarean section including fetal malpresentation, repeat cesarean delivery (previous 1 or 2 scar) were included in the study. The primary outcome measure was blood loss estimation and need of blood transfusions. Statistical analysis was done in SPSS version 21.0.
Results: The average age of women was 30.1 years in combination and 30.2 years in AMTSL alone group. The gestational age was 38.7 weeks in the combination group and 39.0 weeks in the AMTSL alone group. In the combination group, the average blood loss was 441.1 ml whereas in the AMTSL alone group it was 461.2 ml. The number of blood transfusions were remarkebly greater in-the AMTSL alone group compared to combination group (15.4% versus 1.6%, p-value, 0.008). Frequency of postpartum hemorrhage was 0 (0.0%) in-the combination compared to 2 (3.17%) in AMTSL alone group.
Conclusion: The reduction of blood loss was not significant with the addition of misoprostol with AMTSL in elective LSCS. However, blood transfusions and additional uterotonics were significantly reduced with additional misoprostol compared to AMTSL alone.
References
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Dr Javeria Mumtaz
Assistant Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan
Dr Rizwana Gull
Assistant Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan
Dr Sajida Asghar
Associate Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan
Dr Saniya Naheed
Associate Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan
Dr Ammarah Nadeem
Assistant Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan
Dr Anisa Saleem
Assistant Professor, Department of Obstetrics and Gynaecology, HBS Medical and Dental College, Islamabad, Pakistan