Preoperative Versus Postoperative Sublingual Misoprostol in Reducing Blood Loss during and after Primary Elective Cesarean Section

Background: One of the major risks associated with cesarean sections (CS) is blood loss. According to earlier studies, misoprostol effectively lowers intraoperative blood loss during caesarian sections and in the primary postpartum period regardless of how it is taken. However the best time of administration of misoprostol to decrease blood loss is still under discussion. This study aimed to compare the effect of preoperative vs. postoperative administration of 400µg sublingual misoprostol in decreasing blood loss both intraoperative and 24 hours postoperative. Methods: This randomized clinical trials study conducted at Zagazig university hospital and Sohag teaching hospital obstetric outpatient clinics. Included two groups of patients scheduled for elective primary caesarian delivery each group include 34 patient, group one was instructed to administer 400ug misoprostol sublingually preoperatively and the other group postoperatively. All patients were subjected to full clinical examination including Obstetric ultrasonography. Results: The intraoperative blood loss in group 2 was 426.5±6.2ml, compared to 395.1±4.1ml in group 1, and the 24-hour postoperative blood loss was 85.4±8.6ml s. 62.3±91ml, respectively. Significant difference (P < 0.05) between the two investigated groups in hemoglobin and HCT postoperatively, with the preoperative sublingual group having higher levels than the postoperative group. Hemoglobin and HCT levels before and after treatment did not, however, differ statistically significantly. Conclusion: Although fever and chills could still occur, preoperative administration of sublingual misoprostol (400μg) during CS is preferable to postoperative administration since it is linked to less intraoperative and postoperative blood loss and a lower decline in hemoglobin levels