A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section

Background. Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent , has been reported to be useful in the prevention and treatment of postpar tum hemorrhage by several investigators but its use during cesarean section has not been described. The objective of this study was to randomly compar e the effectiveness of oral misoprostol with intravenous syntocinon on bloo d loss during elective cesarean sections under regional anesthesia. Methods. Sixty pregnant women were randomized either to receive misoprostol 400 micrograms orally or syntocinon 10 IU intravenously during cesarean se ction. The primary outcome measure was intra-operative blood loss as estima ted by physicians, and by values of preoperative and postoperative hemoglob in concentration and hematocrit. Demographic characteristics of the subject s and outcomes were compared using X-square test for categorical and two-sa mple t-test for continuous data. Results. Baseline characteristics in terms of age, body weight, parity, ges tational age and indications for cesarean section were similar in both grou ps. The estimated blood loss was 545 mi (CI 476-614) in misoprostol group a nd 533 mi (CI 427-639) in syntocinon group (p= 0.85), Differences in preope rative and postoperative hemoglobin and hematocrit values were also similar in both groups. Two women in the misoprostol group and three in the syntoc inon group (p=0.64) required additional oxytocics. One patient in each grou p required blood transfusion. No serious side effects were noted in either group. Conclusion. Oral misoprostol appears to be safe and as effective as intrave nous syntocinon in reduction of intra-operative blood loss during elective cesarean section under regional anesthesia and merits further investigation .