A Study to Assess the Safety and Efficacy of Preoperative vs Postoperative Per Rectal Misoprostol in Lower Segment Cesarean Section to Prevent Postpartum Hemorrhage

Background: Many global gains in reducing maternal mortality can be attributed to the developments in preventing and treating postpartum hemorrhage (PPH). Misoprostol, a synthetic PGE1 analog has been extensively studied in the prevention and treatment of PPH after vaginal delivery, however, its use in conjunction with cesarean delivery has not been investigated as much. The study aimed to assess the effect of rectally administered misoprostol on blood loss before and after cesarean delivery. Material and Methods: This was a prospective comparative study done in our obstetrics and gynecology department at Sarojini Naidu Medical College, Agra. It involved a total of 150 women who were found to be eligible for the study after meeting the inclusion criteria. Its objective was to compare the effectiveness of the rectally administered 600g misoprostol pre -operatively versus post -operatively in minimizing intraoperative blood loss and prevention of PPH in cesarean delivery. The outcomes studied were intraoperative and postoperative blood loss, changes in hemoglobin concentration, and hematocrit, maternal adverse effects, need for additional uterotonics and surgical interventions. The level of significance was set at <0.05. Results: The mean blood loss in the preoperative misoprostol group was 404.25ml whereas, in the postoperative misoprostol group, there was 441.25 ml of blood loss. The difference between the total blood loss in the two groups was found to be statistically significant. (p<0.05) Only 2 patients in group A had PPH whereas 4 patients suffered from PPH in group B. Conclusion: In our study, we witnessed a marked reduction in intraoperative and postoperative blood loss with a decreased fall in the hematocrit indices in the subjects that received preoperative misoprostol. Preoperative rectally administered misoprostol proved to be of greater efficacy than postoperative rectally administered misoprostol in reducing blood loss due to postpartum hemorrhage in cesarean section.