COMPARISON OF MEAN BLOOD LOSS IN CAESAREAN DELIVERY IN PATIENTS TREATED WITH COMBINED OXYTOCIN MISOPROSTOL VERSUS OXYTOCIN ALONE

Main Article Content

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

Keywords

C-Section, Blood Loss, Misoprostol, Oxytocin

Abstract

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

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References

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.