Sweed Mohamed, El-Said Mourad, Abou-Gamrah Amgad, Ali Mohamad
Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
J Obstet Gynaecol Res. 2019 Mar;45(3):585-591. doi: 10.1111/jog.13883. Epub 2019 Jan 7.
Compare the effectiveness of administration of different doses of rectal misoprostol before cesarean section to reduce intra- and postoperative blood loss.
A double-blind randomized clinical trial including 453 term pregnant woman scheduled for elective cesarean section where participants received either 200-, 400- or 600-μg misoprostol rectally before cesarean section. Study medications were administered after catheter insertion and shortly before skin incision. Primary outcome measures were intraoperative blood loss.
The intraoperative blood loss was higher in patients who received 200-μg misoprostol (464.6 ± 143.1 mL) than those who received 400 or 600 μg, yet, no statistical difference was found between the 400- (359.3 ± 120.9 mL) and 600-μg groups (330.8 ± 133.8 mL). The incidence of side effects as fever and chills increases with increasing the dose of misoprostol.
Rectal administration of misoprostol for the prevention of post-partum hemorrhage and decreasing intraoperative blood loss during caesarian section is a good alternative to other uterotonics. Yet, the best dose to be used needs further research to be agreed upon.
比较剖宫产术前不同剂量直肠给予米索前列醇减少术中及术后失血的效果。
一项双盲随机临床试验，纳入453例计划行择期剖宫产的足月孕妇，参与者在剖宫产术前经直肠接受200微克、400微克或600微克米索前列醇。研究药物在插入导尿管后、皮肤切开前不久给予。主要结局指标为术中失血。
接受200微克米索前列醇的患者术中失血量（464.6±143.1毫升）高于接受400微克或600微克的患者，但400微克组（359.3±120.9毫升）和600微克组（330.8±133.8毫升）之间未发现统计学差异。发热和寒战等副作用的发生率随米索前列醇剂量增加而升高。
剖宫产术中直肠给予米索前列醇预防产后出血及减少术中失血是其他宫缩剂的良好替代方法。然而，最佳使用剂量仍需进一步研究确定。
