Effectiveness of Pre-operative Rectal Misoprostol in Reducing Blood Loss during Cesarean Section for Placenta Previa and Manual Removal of Retained Placenta: A Parallel Placebo-Controlled Study

Ubong Akpan; Udeme Asibong; Kazeem Arogundade; Chinyere  Akpanika; Mabel Ekot; Saturday Etuk

doi:10.3889/oamjms.2021.4690

Authors

Ubong Akpan Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
Udeme Asibong Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
Kazeem Arogundade Saving Mothers Giving Life Initiative, Pathfinder International, Watertown, MA, United States
Chinyere Akpanika Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
Mabel Ekot Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
Saturday Etuk Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria

DOI:

https://doi.org/10.3889/oamjms.2021.4690

Keywords:

Postpartum hemorrhage, Blood transfusion, Uterotonics

Abstract

BACKGROUND: Primary postpartum hemorrhage (PPH) contributes significantly to the high maternal mortality ratio, especially in the low resource nations. Placenta previa and retained placenta are major causes of postpartum hemorrhage. Uterotonics like misoprostol are medication used to improve uterine contractility with the purpose of reducing uterine bleeding after delivery of baby. Most studies on misoprostol for the prevention of obstetric hemorrhage have been focusing on its postpartum use.

AIM: The aim of this study was to assess the effectiveness of pre-operative misoprostol in reducing blood loss during cesarean section for placental previa and manual removal of retained placenta.

METHODS: This was a placebo-controlled study involving 154 women who were randomly assigned to the treatment and control groups. The study group received 400 ug of misoprostol rectally just before the commencement of the procedure. Estimation of blood loss was done in a standardized way. Data were analyzed using SPSS version 23. The level of significance was set at p < 0.05.

RESULTS: The average age of the participants was 31.64 years. The overall incidence of PPH was comparable in both groups (0.070), however, misoprostol group experienced lower incidence of severe PPH compared to the placebo (p = 0.013). Other maternal and perinatal outcomes were comparable.

CONCLUSION: Excessive intraoperative and immediate post-operative bleeding can be prevented with pre-operative misoprostol. It should be made available for high-risk obstetrics procedures.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Mehasseb K, Konje JC. Placental abnormalities. In: Lynch C, Keith LG, Lalonde AB, Karoshi M, editors. A Textbook of Postpartum Haemorrhage. Duncow, UK: Sapiens Publishing; 2006. p. 80-95.

Knight M, Callaghan WM, Berg C, Alexander S, BouvierColle MH, Ford JB, et al. Trends in postpartum haemorrhage in high resource countries: A review and recommendations from the international postpartum haemorrhage collaborative group. BMC Pregnancy Childbirth 2009;9:55. https://doi.org/10.1186/1471-2393-9-55

Thurn L, Wikman A, Westgren M, Lindqvist PG. Massive blood transfusion in relation to delivery: Incidence, trends and risk factors: A population-based cohort study. BJOG. 2019;126(13):1577-86. https://doi.org/10.1097/01.aoa.0000693684.70869.3a PMid:31483935

Bellad MB, Goudar S. Misoprostol: Theory and practice. In: Lynch CB, Keita LG, editor. A Textbook of Postpartum Haemorrhage. Duncow, UK: Sapiens Publishing; 2006. p. 114-26.

Chickakli LO, Atrash HK, Mackay AP, Musani AS, Berg CJ. Pregnancy-related mortality in the United states due to haemorrhage: 1979-1992. Obstet Gynecol. 1999;94(Pt 1):721- 5. https://doi.org/10.1097/00006250-199911000-00015 PMid:10546717

Chong YS, Su LL, Arulkumaran S. Misoprostol: A quarter century of use, abuse, and creative misuse. Obstet Gynecol Survey. 2004;59(2):128-40. https://doi.org/10.1097/01.ogx.0000109168.83489.66 PMid:14752301

Elsedeek MS. Impact of preoperative rectal misoprostol on blood loss during the after elective caesarean delivery. Int J Gynaecol Obst. 2012;118(2):149-52. https://doi.org/10.1016/j.ijgo.2012.03.038 PMid:22698700

Afolabi MA, Ezeoke GG, Saidu R, Ijaiya MA, Adeniran AS. Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reduction blood loss during abdominal myomectomy: A randomized controlled trial. J Turk Gercynecul Assoc. 2019;20(1):23-30. https://doi.org/10.4274/jtgga.galenos.2018.2018.0049 PMid:30499282

Bajwa SK, Bajwa SJ, Kaur H, Goraya PS, Singh A, Kaurlshar H. Management of third stage of labour with misoprostol: A comparison of three routes of administration. Perspect Clin Res. 2012;3(2):102-8. https://doi.org/10.4103/2229-3485.100666 PMid:23125961

Ngwenya S. Postpartum haemorrhage: Incidence, risk factors, and outcomes in a low resource setting. Int J Women Health. 2018;8:647-50. https://doi.org/10.2147/ijwh.s119232 PMid:27843354

Maged AM, Farzi T, Shalahy MA, Samy A, Rabee MA, Ali AS, et al. A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective caesarean delivery. Int J Gynaecol Obstet. 2019;147(1):102-7. https://doi.org/10.1002/ijgo.12922 PMid:31304593

Hofmeyr GJ, Giilmezoglu AM, Novikova N, Linder V, Ferreira S, Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: A systemic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ. 2009;87(9):666-77. https://doi.org/10.2471/blt.08.055715 PMid:19784446

Carroli G, Gusta C, Abalos E, Gulmezogolu AM. Epiemiology of postpartum haemorrhage: A systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999-1012. https://doi.org/10.1016/j.bpobgyn.2008.08.004 PMid:18819848

Hua J, Chen G, Xing F, Scott M. Effect of misoprostol versus oxytocin during caesarean section: A systemic review and meta-analysis. BJOG. 2013;120(5):531-40. https://doi.org/10.1111/1471-0528.12134 PMid:23331998

Eunkin J, Lee JH, Jukim E, Min MW, Ban JS, Lee SG. The effect of type of anaesthesia on intra and post-operative blood loss at elective caesarean section. Korean J Anaesthesiol. 2012;62(2):125-9. PMid:22379566

Afolabi BB, Lesi FA, Mera NA. Regional versus general anasethesia for caesarean section. Cochrane Database Syst Rev. 2006;10:CD004350. https://doi.org/10.1002/14651858.cd004350.pub2 PMid:23076903

Tahan MR, Rashid A. Effects of pre-operative sublingual on uterine tone during isoflurane anasethesia for caesarean section. Rev Bras Anaestesiol. 2012;62(5):625-6. PMid:22999396

Rossoum JN, Hall D, Harvey J. Time between skin incision and delivery during caesarean section. Int J Gynecol Obstet. 2013;121(1):82-5. PMid:23340272

Ragab A, Barakat R, Alsammani MA. A randomized clinical trial of pre-operative versus post-operative misoprostol in elective caesarean delivery. Int J Gynecol Obstet. 2016;132(1):82-4. https://doi.org/10.1016/j.ijgo.2015.06.057 PMid:26522140

Asibong U, Akpan UB, Ayi E. Active management of third stage of labour: Knowledge and practice among non-physician obstetric care-givers in primary health Care Setting in Calabar Municipality, South-South Nigeria. Res Obstet Gynecol. 20018;6(1):9-15.