Abstract

INTRAUTERINE MISOPROSTOL DURING CESAREAN SECTION IN PREVENTION OF PRIMARY POST-PARTUM HAEMORRHAGE

Tahira Ramzan, Shahina Ishtiaq*, Habiba Sharaf Ali and Haleema Yasmin

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Abstract

Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality, particularly in low-resource settings. Effective interventions to minimize blood loss during and after cesarean section (CS) are crucial for improving maternal outcomes. This study aimed to evaluate the efficacy and safety of intrauterine misoprostol (400 mcg) combined with oxytocin in preventing PPH compared to oxytocin alone. A randomized controlled trial was conducted with 300 pregnant women undergoing elective or emergency CS. Participants were assigned to two groups: Group 1 received intrauterine misoprostol (400 mcg) along with an intravenous infusion of oxytocin (10 IU), while Group 2 received only intravenous oxytocin (10 IU). Primary outcomes included estimated blood loss (EBL) during surgery and the need for additional uterotonics. Secondary outcomes assessed postoperative blood loss, hemoglobin and hematocrit changes, and any maternal side effects. Results demonstrated that Group 1 had significantly lower intraoperative blood loss (408.27 ± 123.34 mL vs. 486.04 ± 135.84 mL, p < 0.001) and total estimated blood loss (440.19 ± 257.75 mL vs. 677.38 ± 343.04 mL, p < 0.001) compared to Group 2. Postoperative hemoglobin and hematocrit levels were better preserved in Group 1, reducing the need for blood transfusion. The requirement for additional uterotonics was lower in the misoprostol group, though not statistically significant. No significant differences in side effects were observed between the two groups. The findings suggest that intrauterine misoprostol, when combined with oxytocin, is an effective and safe intervention for reducing intraoperative and postoperative blood loss during CS. This approach has the potential to improve maternal outcomes and should be considered, especially in settings with limited healthcare resources.

Keywords: Postpartum Hemorrhage, Cesarean Section, Intrauterine Misoprostol, Oxytocin, Blood Loss, Maternal Mortality, Uterotonic Agents.