Sweed Mohamed S, El-Saied Mourad M, Abou-Gamrah Amgad E, El-Sabaa Haitham A, Abdel-Hamid Mohamed M, Hemeda Hossam, Mansour Ahmed M, Shawky Mohamed E, El-Sayed Medhat A, Mohamed Radwa M
Obstetrics and Gynecology Department, Ain Shams University, Cairo, 16646, Egypt.
Arch Gynecol Obstet. 2018 Dec;298(6):1115-1122. doi: 10.1007/s00404-018-4894-2. Epub 2018 Oct 5.
The commonest surgical procedure for women is cesarean delivery. Postpartum hemorrhage and intra-operative blood during cesarean delivery is a major concern to all obstetricians. This study was conducted to assess the efficacy of the adjuvant use of misoprostol and oxytocin in decreasing intra-operative blood loss in cesarean delivery.
This was a double-blinded randomized clinical trial including 636 term pregnant woman scheduled for cesarean section at Ain Shams University Maternity Hospital, Cairo, Egypt, between February 2013 and February 2014. Participants received either 400-μg misoprostol rectally or sublingually or placebo before cesarean section together with 5-IU oxytocin IV. The main outcome measure was intra-operative blood loss. Difference between the three groups was analyzed using one-way ANOVA test (for numeric variables) and Chi-square test (for categorical variables). P < 0.05 was considered statistically significant.
Intra-operative blood loss was higher in patients who did not receive misoprostol (Placebo Group) (295-1075 ml, 641.7 ± 135.7) than those who received it, regardless the route of administration, rectal (135-830 ml, 457.5 ± 140.7; P < 0.001), and sublingual (135-680 ml, 357.8 ± 129.7; P < 0.001). In addition, sublingual route was associated with significantly lower estimated intra-operative blood loss compared to rectal administration (P < 0.001).
Misoprostol with oxytocin is an effective drug-combination for decreasing intra-operative blood loss during cesarian section with clinical superiority to sublingual over rectal route.
女性最常见的外科手术是剖宫产。剖宫产术中产后出血和术中失血是所有产科医生主要关注的问题。本研究旨在评估米索前列醇和缩宫素联合使用在减少剖宫产术中失血方面的疗效。
这是一项双盲随机临床试验，纳入了2013年2月至2014年2月期间在埃及开罗艾因夏姆斯大学妇产医院计划行剖宫产的636名足月孕妇。参与者在剖宫产术前接受400μg米索前列醇直肠给药或舌下给药或安慰剂，同时静脉注射5IU缩宫素。主要观察指标是术中失血量。使用单因素方差分析（用于数值变量）和卡方检验（用于分类变量）分析三组之间的差异。P<0.05被认为具有统计学意义。
未接受米索前列醇的患者（安慰剂组）术中失血量较高（295 - 1075ml，641.7±135.7），高于接受米索前列醇的患者，无论给药途径如何，直肠给药组（135 - 830ml，457.5±140.7；P<0.001）和舌下给药组（135 - 680ml，357.8±129.7；P<0.001）。此外，与直肠给药相比，舌下给药途径的估计术中失血量显著更低（P<0.001）。
米索前列醇与缩宫素联合使用是减少剖宫产术中失血的有效药物组合，临床疗效上舌下给药优于直肠给药。
