Impact of pre-operative 200 ?g (P/R) per rectal misoprostol on blood loss during and after Cesarean delivery

Background: Intra-partum and early postpartum blood loss are increased in conjunction with Cesarean delivery. Misoprostol is a potent uterotonic agent that has been extensively studied in the prevention and treatment of PPH after vaginal delivery, however, its use in conjunction with CD has not been investigated as much. Objective: To evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective Cesarean delivery. Materials and methods: A randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. The study group (n=100) received 200 ?g of misoprostol. The control group (n=100) received placebo. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values. Results: The mean intra-operative and postpartum blood loss was lower in the study group than the control group: 374 ± 69.9 ml and 131 ± 31.8 ml versus 401 ± 79.9 and 145 ± 35.6 ml, respectively. The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.3 ± 2.26 and 5.25 ± 2.61, p =0.006). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the two groups. Conclusion: Preoperative administration of 200 ?g rectal misoprostol significantly reduced blood loss related to elective Cesarean delivery.