Efficacy of sublingual misoprostol with intravenous oxytocin for reducing blood loss after vaginal delivery in women at risk of postpartum hemorrhage: A double-blind randomized controlled trial
Keywords:
sublingual misoprostal, oxytocin, postpartum hemorrhage, vaginal delivery, randomized controlled trialAbstract
Postpartum hemorrhage is the most common obstetric complication in those with risk factors. Therefore, consideration of uterotonic agents in addition to standard drugs to prevent early postpartum hemorrhage is necessary. This study aims to examine efficacy of sublingual Misoprostol with intravenous Oxytocin for reducing blood loss after vaginal delivery in women at risk of postpartum hemorrhage. The samples were term pregnant women with risk factors. The experimental group (112) received sublingual misoprostol 400 mcg plus intravenous oxytocin 10 IU; the control group received intravenous oxytocin plus placebo tablets after delivery. Primary outcomes to compare the mean blood loss, and decreased hemoglobin. Secondary outcomes to examine the rate of early postpartum hemorrhage, and adverse avents. Statistical analysis were chi-square test, Mann-Whitney U test, and Independent t-test. Results: there were no statistical differences characteristic in both groups: age, gravida, parity, gestational age, BMI, hemoglobin, risk factors, delivery time, and birth weight. The mean blood loss was significantly lower in the experimental group than the control group (394.73±135.80 ml, 455.79±169.67 ml, p=0.003), mean decreased hemoglobin was significantly lower than the control group (0.88±0.35, 1.11±0.73 g/dl, p=0.026), rate of early postpartum hemorrhage was significantly lower than the control group (17.86, 29.72 %, p=0.043). The experimental group had more shivering and fever than the control group (17.86, 1.75 %, p<0.001 and 51.79, 2.63 %,p<0.001). Conclusion: Sublingual Misoprostol 400 mcg with intravenous Oxytocin 10 IU is effective for reducing blood loss and the rate of early postpartum hemorrhage in women at risk of postpartum hemorrhage. There are no severe side effects, and manageable.
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