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ROLE OF SUBLINGUAL MISOPROSTOL FOR PREVENTION OF POST PARTUM HAEMORRHAGE DURING CAESAREAN SECTION

Prof Dr. Shahina Ishtiaq, Dr. Sheeba Hussain,Dr. Mehreen Yousaf Rana, Dr.Urooj Malik, Dr. Zarnigah

Post-Partum hemorrhage remains the leading cause of maternal deaths worldwide & in low income countries. Increasing rate of caesarean section leads to increase in incidence of PPH as it is one of the predisposing risk factor for development of PPH. Misoprostol is inexpensive, easily available and has been broadly studied in the prevention and treatment of PPH after vaginal delivery; however, its use in conjunction with Cesarean section is not investigated much. The objective of our study was to compare the efficacy and safety of sublingual misoprostol in prevention of post-partum hemorrhage during caesarean delivery with conventional uterotonic agent Oxytocin 30 I U infusion slowly given intravenously. The primary outcome measures were to measure the mean intraoperative and postoperative blood loss, the mean decrease in Hemoglobin, andhematocrit and the use of any additional uterotonic agents. Secondary outcome measures need of blood transfusion, any surgical intervention needed for PPH including hysterectomy, B-Lynch, uterine packing, or any other procedure and length of stay in hospital. DESIGN; A randomized clinical trial conducted at Zia Uddin Hospital Karachi, Pakistan. METHOD:. Two hundred fourteen (214) pregnant women delivering by cesarean section, divided in two groups. Group A :women received sublingual misoprostol 600 microgram at the delivery of baby by C/Section on the time of cord clamping and Oxytocin 30 units in 1000ml of Ringer Lactate slow IV infusion . Group B :women received 30 units of Oxytocin infusion only. Visual assessment of blood loss was calculated by measuring blood in suction apparatus and weighting of sterile swabs and gauze. Blood loss was calculated based on hemoglobin& hematocrit levels before and after caesarian section. RESULT: GROUP A Intra-Operative (2.91 ± 1.575 VS 3.08 ± 1.760) and post-operative blood loss (1.62 ± 0.832 VS 2.01 ± 0.966) was reported reduced in Group A.The post-operativehemoglobin was better as compared to group B. There were less use of other uterotonic agents and blood transfusion in group A woman. No additional surgical procedure for prevention and treatment was needed in any women of group A. GROUP B. intraoperative blood loss was higher. Calculated hematocrit post operatively were reduced (10.68 ± 0.941 VS 9.71 ± 0.833). There was need of additional uterotonic agents (21%)and surgical procedures (7%) to prevent severe hemorrhage in this group. Blood transfusion was needed in 13 % patients. CONCLUSION: Misoprostol reduced blood loss during and after caesarean section significantly thus reducing the incidence of postpartumhemorrhage,blood transfusions and severe maternal morbidity.