Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery

Abstract 

Objective

To compare the effectiveness of oral misoprostol and intravenous oxytocin in reducing blood loss in women undergoing indicated or elective cesarean delivery (CD) under spinal anesthesia.

Methods

In this prospective, double-blind pilot study, 56 parturients who received 5 IU of intravenous oxytocin after cord clamping were randomized to further receive either misoprostol orally and a placebo infusion intravenously or placebo orally and an oxytocin infusion intravenously.

Results

After adjustment was made for the sonographically estimated amniotic fluid volume, there was no statistical difference in blood loss between the 2 groups (mean±S.D., 1083±920 mL in the oxytocin group vs. 970±560 mL in the misoprostol group; P=.59).

Conclusion

Oxytocin followed by oral misoprostol is as effective as an oxytocin injection followed by an oxytocin infusion in reducing postoperative blood loss after CD, and the protocol may be a safe, valuable, and cost-effective alternative to oxytocin alone. Visual estimation of intraoperative blood loss undervalues the effective value of misoprostol use by 30%.

Keywords: Maternal, Morbidity, Mortality, Pregnancy, Postpartum hemorrhage, Cesarean delivery