COMPARISON OF MEAN BLOOD LOSS IN CAESAREAN DELIVERY IN PATIENTS TREATED WITH COMBINED OXYTOCIN MISOPROSTOL VERSUS OXYTOCIN ALONE
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Keywords
C-Section, Blood Loss, Misoprostol, Oxytocin
Abstract
Background: The rise in maternal mortality has been linked to a nationwide increase in C-section rates, however, this surge has outpaced the rise in the caesarean section rate, which has risen from 12.7% to 20.8% from 2001/02 to 2012-13. According to Pakistan's population and demographic health survey, the prevalence of C-sections has increased from 2.7% in 1990-91 to 15.8% in 2012-13. Subsequently, obstetric haemorrhage continues to be a major cause of maternal morbidity and mortality.
Objective: To compare the mean intra-operative blood loss in cesarean delivery in patients treated with combined oxytocin misoprostol versus oxytocin alone.
Study Design: A randomized controlled trial
Place And Duration: This study was conducted in Jinnah Hospital, Lahore from November 2021 to April 2022
Methodology: A total of 170 patients were inducted, 85 of them in group A were treated with oxytocin alone 85 in group B were treated with oxytocin plus misoprostol after cesarean section. The patients in Group A were given 10 IU of oxytocin intravenously and then 20 IU were added in 1000ml ringer lactate and were transfused at the rate of 1000 cc/hour. However, in group B, the patients were given oxytocin in the same way but after the delivery of the placenta, they were also given a 400-microgram sublingual misoprostol tablet.
Results: The mean age of the patients was 29.4±5.2 years. The majority (n=105, 61.8%) of the women were aged between 18-29 years with 65 (38.2%) women aged 30 years and above. The change in blood pressure ranged from 10 mmHg to 25 mmHg with a mean of 17.3±4.9 mmHg. The parity of the subjects ranged from 2 to 5 with a mean of 3.3±1.1. Out of 170, 95 (55.9%) women had a parity between 2 to 3 while 75 (44.1%) women had a parity of 4 to 5. The duration of the surgical procedure ranged from 32 to 68 minutes with a mean of 49.6±9.6 minutes. The amount of blood was significantly lesser in women receiving additional misoprostol with oxytocin as compared to oxytocin alone (537.53±29.09 vs. 646.84±21.99 ml; p-value<0.001).
Conclusion: Sublingual misoprostol was found to be superior to the standard practice of oxytocin alone in reducing intra-operative blood loss in women undergoing caesarean delivery
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Noor ul Huda
Resident Obstetrics and Gynaecology, Jinnah Hospital, Lahore Pakistan.
Anam Rashid
Consultant Obstetrics and Gynaecology, Jinnah Hospital, Lahore Pakistan.
Rabia khursheed
Consultant Obstetrics and Gynaecology, Jinnah Hospital, Lahore Pakistan.
Dania Nayyer
Consultant Obstetrics and Gynaecology, Jinnah Hospital, Lahore Pakistan.
Mehwish Saleem
Consultant Obstetrics and Gynaecology, THQ Hospital, Mian mir Lahore Pakistan.
Yusra Javed
Consultant Obstetrics and Gynaecology, Jinnah Hospital, Lahore Pakistan.