The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Pakniat, Hamideh; Khezri, Marzieh Beigom

doi:10.1007/s13224-014-0607-3

Cited by 18 publications

(10 citation statements)

References 24 publications

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“…Sublingual misoprostol is reported to have minimal adverse effects. 23 The decision regarding the dose of misoprostol was based upon the urgent need of fast and best effective dose at the threshold of 350 ml of blood loss. On reviewing the studies in context of dose, it was found that those reporting no additional benefit of misoprostol as an adjunct have used the dose of ≤600 µg.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Mishra

Nekkanti

Barma

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: To evaluate the effect of adjunctive misoprostol in preventing postpartum haemorrhage (PPH) by selective administration above threshold bleeding in order to reduce its side effects in comparison with primary prevention with oxytocin alone.Methods: It was a prospective observational cohort study conducted at Government medical College of central India. Population included 500 low risk women delivering vaginally. After having received oxytocin as primary prevention, women were monitored for bleeding by quantitative assessment of blood loss (QBL) using an innovative drape (kept prepared at the point of care) and once bleeding crossed 350 ml mark, alternate women were given 800 µg misoprostol sublingually as an adjuvant (study group) and compared with those who did not receive adjuvant misoprostol (control group). Main outcome measure: Comparing the incidence of PPH and side effects between study and control group.Results: 150 women had blood loss >350 ml which constituted 76 women in study and control group each. Incidence of PPH was significantly less in the study group (10.52 versus 22.36%, p<0.05, RR 0.470 95% CI= 0.216-1.024). Though side effects were more (38.15%) in study group but these were mild in nature and when the number was extrapolated to all recruited women, the incidence came down to 11.6%.Conclusions: Sequential adjuvant misoprostol at 350 ml blood loss after primary prevention with oxytocin is an effective and pragmatic strategy for preventing PPH when compared to oxytocin alone but with reduced overall side effects owing to less number of women receiving misoprostol.

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Section: Discussionmentioning

confidence: 99%

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Mishra

Nekkanti

Barma

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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“…Routine prophylactic use of uterotonic drugs, as combination of oxytocin with misoprostol, significantly lessens the risk of PPH. 25 Some studies show that oxytocin reduces PPH and the need for therapeutic uterotonic agents by over 40%, and that adding mysoprostol is more effective than using oxytocin alone. 26,27 Once the PPH is recognized, the conservative first line initial therapy is gaining uterine tonicity (up to 40 IU of oxytocin should be administered over 30 minutes), setting up a monitoring system and identifying the cause of bleeding (tone, tissue, trauma, and thrombin).…”

Section: Discussionmentioning

confidence: 99%

Case study of atonic internal postpartum haemorrhage following severe preeclampsia and caesarean section

Bordo

Grabe

2020

Int J Reprod Contracept Obstet Gynecol

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Postpartum haemorrhage is most often diagnosed by visualizing external vaginal bleeding, however, in some cases the bleeding may be internal, which significantly increases the risk for delayed diagnosis. We present a case report of a puerperal woman with delayed diagnosis of internal postpartum haemorrhage, which is caused by the development of a Couvelair’s uterus after caesarean section, resulting in an acute hysterectomy.

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“…However, it may be insufficient for prevention of postpartum hemorrhage (PPH), for example in patients who have hepatorenal disease, psychotic disorders, chronic anemia, allergy to melatonin, longterm antidepressant or analgesic drug use. Oxytocin may cause severe cardio-vascular complications, such as hypotension, due to vasodilation, especially in high doses (1). Melatonin, N-acetyl-5-methoxy tryptamine, is a methoxyindole derived from tryptophan and totally secrets by hypophysis.…”

Section: Introductionmentioning

confidence: 99%

Effect of melatonin on postpartum hemorrhage in vaginal delivery: a prospective randomized double-blind study

et al. 2021

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Background. The similarities between the melatonin and oxytocin signaling could promote myometrium contractility. We conducted this study to determine the effect of melatonin on the bleeding during and after vaginal delivery. Methods. The current double-blind randomized clinical trial was conducted on 140 pregnant women at term with labor pain. Subjects in the melatonin group received three sublingual doses of melatonin from labor room staff as follows: 6 mg in 7 cm dilatation, 3 mg after delivery of the fetus and 3 mg one hour after the delivery. The same schedule was conducted for the subjects in the placebo group by giving the placebo. The hemoglobin levels before and 24 hours after vaginal delivery, the hemodynamic variables were recorded. Results. There was a significant difference between the groups regarding the mean of hematocrit changes in the melatonin (3.59 ± 2.89) and placebo (5.29 ± 3.19) groups (P = 0.001). The mean variation of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) show a significant difference among two groups of the study (P = 0.021, P = .020 and 0.001, respectively). Conclusions. The sublingual of melatonin to pregnant women with labor pain could reduce the amount of blood loss after the vaginal delivery. Furthermore, melatonin could provide hemodynamic stability.

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The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Cited by 18 publications

References 24 publications

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Adjunctive misoprostol for prevention of post-partum haemorrhage: a pragmatic strategy of selective sequential administration

Case study of atonic internal postpartum haemorrhage following severe preeclampsia and caesarean section

Effect of melatonin on postpartum hemorrhage in vaginal delivery: a prospective randomized double-blind study

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