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Noor ul Huda
Anam Rashid
Rabia khursheed
Dania Nayyer
Mehwish Saleem
Yusra Javed


C-Section, Blood Loss, Misoprostol, Oxytocin


Background: The rise in maternal mortality has been linked to a nationwide increase in C-section rates, however, this surge has outpaced the rise in the caesarean section rate, which has risen from 12.7% to 20.8% from 2001/02 to 2012-13. According to Pakistan's population and demographic health survey, the prevalence of C-sections has increased from 2.7% in 1990-91 to 15.8% in 2012-13.  Subsequently, obstetric haemorrhage continues to be a major cause of maternal morbidity and mortality. 

Objective: To compare the mean intra-operative blood loss in cesarean delivery in patients treated with combined oxytocin misoprostol versus oxytocin alone. 

Study Design: A randomized controlled trial 

Place And Duration:  This study was conducted in Jinnah Hospital, Lahore from November 2021 to April 2022 

Methodology: A total of 170 patients were inducted, 85 of them in group A were treated with oxytocin alone 85 in group B were treated with oxytocin plus misoprostol after cesarean section. The patients in Group A were given 10 IU of oxytocin intravenously and then 20 IU were added in 1000ml ringer lactate and were transfused at the rate of 1000 cc/hour. However, in group B, the patients were given oxytocin in the same way but after the delivery of the placenta, they were also given a 400-microgram sublingual misoprostol tablet.

Results: The mean age of the patients was 29.4±5.2 years. The majority (n=105, 61.8%) of the women were aged between 18-29 years with 65 (38.2%) women aged 30 years and above. The change in blood pressure ranged from 10 mmHg to 25 mmHg with a mean of 17.3±4.9 mmHg. The parity of the subjects ranged from 2 to 5 with a mean of 3.3±1.1. Out of 170, 95 (55.9%) women had a parity between 2 to 3 while 75 (44.1%) women had a parity of 4 to 5. The duration of the surgical procedure ranged from 32 to 68 minutes with a mean of 49.6±9.6 minutes. The amount of blood was significantly lesser in women receiving additional misoprostol with oxytocin as compared to oxytocin alone (537.53±29.09 vs. 646.84±21.99 ml; p-value<0.001).

Conclusion: Sublingual misoprostol was found to be superior to the standard practice of oxytocin alone in reducing intra-operative blood loss in women undergoing caesarean delivery

Abstract 61 | pdf Downloads 42


1. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018;15(1):e1002494.
2. Miseljic N, Basic E, Miseljic S. Causes of an increased rate of caesarean section. Mater Sociomed 2018;30(4):287-9.
3. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. Plos One2016;11(2): 01-11.
4. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J et al. On behalf of the WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. LancetGlobHealth 2015;3(5):e260-70.
5. Mumtaz S, Bahk J, Khang YH. Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013. Plos One2017;12(10):01-13.
6. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet2010;375(9713):490-99.
7. Asıcıoglu O, Gungorduk K, Asıcıoglu BB, Yıldırım G, Gungorduk OC, Ark C. Unintended extension of the lower segment uterine incision at cesarean delivery; a randomized comparison of sharp versus blunt techniques.Am J Perinatol2014;31(10):837–44
8. Kellie FJ. Medical methods for preventing blood loss at caesarean section. Cochrane Database Syst Rev 2018;(2):CD007576.
9. Maswime S, Buchmann EJ. Why women bleed and how they are saved: a cross-sectional study of caesarean section near-miss morbidity. BMC Pregnancy Childbirth 20I7;17:15.
10. Lerman B, Harricharran T, Ogunwobi O. Oxytocin and cancer: An emerging link. World J Clin Oncol 2018;9(5):74-82.
11. Wu HL, Marwah S, Chen XW. Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis. Sci Rep 2017;7:1664.
12. Pakniat H, Khezri MB. The effect of combined oxytocin-misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery: a prospective randomized double-blind study. J Obstet Gynaecol India 2015;65(6):376-81.
13. Khan FA, Khan M, Ali A, Chohan U. Estimation of blood loss during Caesarean section: an audit. J Pak Med Assoc 2006;56(12):572-5.
14. Raees M, Yasmeen S, Jabeen S, Utman N, Karim R. Maternal morbidity associated with emergency versus elective caesarean section. J Postgrad Med Inst 2012;27(1):55-62.
15. Eusaph AZ, Iqbal S, Rana T, Asghar F. Evaluation of practices of blood transfusion in various indication of caesarean section. Ann KEMU 2011;17(2):183-6.
16. Akinola OI, Fabamwo AO, Tayo AO, Rabiu KA, Oshodi YA, Onyekwere CA. Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria. BMC Pregnancy Childbirth 2010;10:57.
17. Zhao L, Zhao XL, Cheng YM, Xu YY. Effects of different types of placenta previa on pregnancy outcome. Maternal Child Health China 2016;31(6):1163-5.
18. Chen CY, Su YN, Lin TH, Chang Y, Horng HC, Wang PH, et al. Carbetocin in prevention of postpartum hemorrhage: Experience in a tertiary medical center of Taiwan. Taiwan J Obstet Gynecol 2016;55(6):804-9.
19. Arshad S, Siddique S, Arshad R. A comparison of satisfaction; spinal versus general anesthesia for cesarean section. Pak Armed Forces Med J 2013;63(3):1-5.
20. Maheshwari D, Ismail S. Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. J Anaesthesiol Clin Pharmacol 2015;31(2):196-200.
21. Biler A, Ekin A, Ozcan A, Inan AH, Vural T, Toz E. Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience. Pak J Med Sci 2017;33(5):1074-9.
22. Kadour-Peero E, Bleicher I, Vitner D, Sloma R, Bahous R, Levy E, et al. When should repeat cesarean delivery be scheduled, after two or more previous cesarean deliveries? J Matern Fetal Neonatal Med 2018;31(4):474-80.
23. Qublan HS, Tahat Y. Multiple cesarean section; the impact on maternal and fetal outcome. Saudi Med J 2006;27(2):210-4.
24. Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, et al. Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases. Taiwan J Obstet Gynecol 2010;49(4):425-31.
25. Sood AK, Singh S. Sublingual misoprostol to reduce blood loss at cesarean delivery. J Obstet Gynaecol India 2012;62(2):162-7.
26. Rasri W. Intrauterine misoprostol plus intravenous oxytocin for reduction of blood loss in cesarean delivery. Thai J Obstet Gynaecol 2018;26(4):237-45.
27. Khalid A, Aman S, Jhatial I, Talreja W, Hussain W, Wadho S, Shahan MP. Factors Affecting Non Compliance with Exclusive Breastfeeding Among Mothers: A Survey at District Hospital Dadu. Pakistan Journal of Medical & Health Sciences. 2022;16(11):761-
28. Shahani Z, Shaikh AR, Gemnani VK, Abro K, Aizuddin AN, Manaf MR, Shahani MP. Neonatal Morbidity Patterns and Admission Outcomes: A Cross Sectional Study at a Tertiary Care Hospital in Pakistan. Journal of Pharmaceutical Research International. 2022 Jan 10:72-6.