Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery

ObjectiveTo evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective cesarean delivery.MethodsA randomized controlled trial was conducted among 400 women scheduled for elective cesarean delivery. The study group (n = 200) received 400 μg of misoprostol. The control group (n = 200) received placebo. Study medications were administered rectally after catheter insertion and shortly before skin incision. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values.ResultsThe mean intra-operative and postpartum blood loss was significantly lower in the study group than the control group: 429 ± 234 mL and 185 ± 95 mL versus 620 ± 375 mL and 324 ± 167 mL, respectively (P = 0.001 for both comparisons). The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.62 ± 2.45 versus 8.15 ± 3.84; P = 0.02). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the 2 groups.ConclusionPreoperative treatment with 400 μg rectal misoprostol significantly reduced blood loss related to elective cesarean delivery.Clinical trial registration No.:ACTRN12611000638932.