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Anam Rashid
Rabia Khursheed
Ulvina Khalid
Noor Ul Huda
Yusra Javed
Mehwish Saleem


Misoprostol, Blood loss, Caesarean section


OBJECTIVE: To determine the mean postoperative blood loss in patients undergoing caesarean section given preoperative misoprostol.

 BACKGROUND: Caesarean section (CS) is a vital and common surgical procedure that frequently saves both the mother's and the baby's lives. Cases of C-sections have increased enormously around the world in recent years. Researchers have put a lot of effort to study the complications related to C-sections in order to combat those for prevention and control of perinatal mortality and morbidity. 


OBJECTIVE: To assess the mean postoperative blood loss in patients undergoing cesarean section given preoperative misoprostol

 STUDY DESIGN: A cross-sectional study

PLACE AND DURATION:  This study was conducted in Jinnah Hospital Lahore from July 2019 to January 2020

MATERIALS AND METHODS: Using a non-probability consecutive method, 60 study subjects were indicted for the study. Gravid females presented at  ≥  37  weeks of gestation  (as per dating scan) with labour arrest (>3 hours duration at 5 cm dilatation or > 4 hours duration at 6 cm dilatation on clinical examination) or abnormal CTG undergoing CS with ages in the range of 20-40 years were included in the study.

 RESULTS: The mean age was 31.0±5.0 years, mean gestational age, BMI, duration of surgery and mean blood loss were 38 .6±1. 1 week, 27.3±2.6 kg/m2, 39.5±10.3 minutes and   255.08±117.39 ml respectively.

There were 22 primigravida (36.7%) and 38 multigravida (63.3%). According to the findings, 43 (71.67%) women had a gestational age of 37 to 39 weeks and 17 (28.33%) women had a gestational age of 40-41 weeks, 11 (18.33%) women had BMI more than 25 Kg/m2 and 49 (81.67%) women had BMI less than 25 Kg/m2.

 CONCLUSION: The study concluded that sublingual misoprostol is an excellent uterotonic drug in the management of postoperative caesarean section blood loss.  Clinical guidelines and treatment procedures should be updated to reflect the most recent information on the efficacy of misoprostol for the treatment of blood loss associated with caesarean delivery.

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1. Mylonas I, Friese K . Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int 2015;112:489-95.
2. Kaplanoglu M, Karateke A, Un B, Akgor U, Baloğlu A. Complications and outcomes of repeat cesarean section in adolescent women. Int J Clin Exp Med 2014;7:5621 – 8.
3. Hung HW, Yang PY,Yan YH,Jou HJ,Lu MC,Wu SC. Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women. J Matern Fetal Neonatal Med 2016;29:1665-72.
4. Anjum A, Manzoor M, Manzoor N, Shakir HA . Prevalence of anemia during pregnancy in district Faisalabad, Pakistan. Punjab Univ J Zool 2015;30: 15-20.
5. Sahu S, Hemlata, Verma A. Adverse events related to blood transfusion. Indian J Anaesth 2014;58: 543-51.
6. Stephenson ML, Wing DA . A novel misoprostol delivery system for induction of labor: clinical utility and patient considerations. Drug Des Devel Ther 2015;9:2321-7.
7. El Tahan MR, Warda OM, Rashad A, Yasseen AM,Ramzy EA, Ahmady MS, et al. Effects of preoperative sublingual misoprostol on uterine tone during isoflurane anesthesia for cesareansection. Rev Bras Anestesiol 2012;62:625-35.
8. Acharya G, Al-Sammarai MT, Patel N . Arandomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section.Acta Obstet Gynecol Scand 2001;80:245-50.
9. Munn MB, Owen J, Vincent R . Comparison of two oxytocin regimens to prevent uterine atony at cesarean delivery: a randomized controlled trial.Obstet Gynecol 2001;98:386-90 .
10. Goldberg AB, Greenberg MB, Darney PD . Misoprostol and pregnancy. N Engl J Med 2001; 344:38-47.
11. Zhao Y, Li X, Peng Y. Clinical study on reduction of postpartum bleeding in cesarean section by misoprostol. Zhonghua Fu Chan Ke Za Zhi 1998;33:403-5.
12. Lokugamage AU, Paine M, Bassaw-Balroop K, et al. Active management of the third stage at caesarean section: a randomised controlled trial of misoprostol versus syntocinon. Aust N Z J Obstet Gynaecol 2001;41:411-4.
13. Hamm J, Russell Z, Botha T . Buccal misoprostol to prevent hemorrhage at cesarean delivery: a randomized study. Am J Obstet Gynecol 2005;192: 1404-6 .
14. Vimala N, Mittal S, Kumar S. Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section. Int J Gynaecol Obstet 2006;92:106- 110.
15. Lapaire O, Schneider MC, Stotz M . Oral misoprostol versus intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet 2006;95:2-7.