Use of Misoprostol in the Prevention of Postpartum Haemorrhage Following Caesarean Section
DOI:
https://doi.org/10.61561/ssbgjms.v7i01.141Keywords:
Postpartum haemorrhage, Rectal misoprostol, Caesarean section, Uterotonic, PPH preventionAbstract
Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality, particularly in low-resource settings. Misoprostol, a synthetic prostaglandin E1 analogue, is inexpensive, thermo-stable, and easy to administer; it is increasingly used off-label in obstetrics for PPH prevention and treatment, but locally generated evidence on its rectal use during caesarean section in Bangladesh remains limited.
Objective: To ascertain the use of rectal misoprostol in the prevention of postpartum haemorrhage following caesarean section.
Methods: This was a cross-sectional comparative study conducted in the Department of Obstetrics and Gynaecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, from November 2012 to April 2013. A total of 110 pregnant women at ≥37 weeks of gestation undergoing caesarean section were enrolled by consecutive sampling and assigned to two groups of 55 each: Group A (Trial group) received 400 mcg rectal misoprostol immediately after delivery of the baby in addition to standard oxytocin, while Group B (Control group) received standard oxytocin alone (10 IU IV/IM) as per WHO 2012 active management protocol. Outcomes included intra- and post-operative blood loss, incidence of PPH, and side effects. Data were analysed using SPSS version 16.0; chi-square and Fisher's exact tests were used for categorical variables and independent-samples t-test for continuous variables, with p<0.05 considered significant.
Results: The mean age was 21.90±3.73 years in Group A and 22.83±3.51 years in Group B. The majority were housewives (89.1% in Group A vs 96.4% in Group B) and primigravida (92.7% vs 96.4%). Blood loss <1000 ml was significantly more common in Group A than Group B (61.8% vs 29.1%), while blood loss >1000 ml was more frequent in Group B than Group A (70.9% vs 38.2%; p=0.001). Postpartum haemorrhage occurred in 3.6% of women in each group. Pyrexia was observed in 9.1% of Group A and 7.3% of Group B, and nausea in 1.8% and 3.6% respectively, with no significant difference (p=0.676).
Conclusion: Rectal misoprostol given as an adjunct to standard oxytocin was associated with significantly reduced intra- and post-operative blood loss following caesarean section, with a comparable side-effect profile. Given its low cost, thermal stability, and ease of administration, rectal misoprostol may have an important adjunctive role in PPH prevention in tertiary settings, and its use should continue to be explored in adequately powered randomized trials.
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