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Subject Area

Orthopedic Surgery

Article Type

Original Study

Abstract

Objectives To compare between the effect of preoperative sublingual versus rectal misoprostol on blood loss during and after elective cesarean section. Background Cesarean delivery is the commonest major women's surgery worldwide. Postpartum hemorrhage is a major cause of maternal mortality, mainly in developing countries. Misoprostol is one of the synthetic PGE1 analogs with strong uterotonic activity. Patients and methods This randomized controlled clinical trial was conducted in the Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University Hospital, in the period from September 2019 to July 2020. The study included 135 term pregnant women randomized into three equal groups (rectal, sublingual, and control). Full history, general examination, obstetric examination, routine investigation, and obstetrics ultrasound were done. All participants underwent elective cesarean delivery under spinal anesthesia. The patient was catheterized then the rectal or sublingual misoprostol tablets (400 μg) were administered according to a randomization plan. All cases received 10 IU of oxytocin by slow intravenous injection after cord clamping. Results Intraoperative blood loss was lowest in sublingual group (352.5 ± 116.91) followed by rectal group (438.2 ± 190.19) and was highest in control group (621.2 ± 207.25). Postoperative hematocrit was lowest in the control group (33 ± 3.44) followed by the rectal group (35.09 ± 4.58) and was highest in the sublingual group (35.5 ± 3.46). Conclusion Misoprostol with oxytocin is an effective drug combination to prevent postpartum hemorrhage and decrease intraoperative blood loss during cesarean section with better results through sublingual than rectal route.

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