Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Background: Blood loss is one of the important complications during cesarean section(CS). Previous reports have shown that misoprostol is effective in reducingblood loss during and after CS. However, the optimum time for itsadministration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration ofsublingual misoprostol (400 μg) in reducing the amount of blood loss during and24 hours after CS. Setting: Obstetrics and Gynecology Department,Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 andJuly 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lowersegment CS at term (≥37 weeks) with normal fetal heart tracing who accepted toparticipate in the study. Patients were divided into two groups; Patientsassigned to group 1 received 400 μg sublingual misoprostol immediately afterurinary catheterization and before skin incision, while patients assigned togroup 2 received sublingual misoprostol immediately after skin closure. Theprimary outcome was the estimation of intraoperative and postoperative bloodloss for 24 hours. Results: There was a significant reduction in theintraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs.460.99 ± 74.66 ml, respectively). Also, there was a significant reduction inpostoperative blood loss in group 1 compared with group 2 with a statisticalsignificance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperativehemoglobin and Hematocrit values were significantly higher in group 1 comparedwith group 2. Conclusions: Preoperative administration of sublingualmisoprostol (400 μg) during CS is better than postoperative administration asit is associated with a reduction in the amount of intraoperative andpostoperative blood loss and drop in hemoglobin level.