Bahadur Anupama, Khoiwal Kavita, Bhattacharya Namrata, Chaturvedi Jaya, Kumari Ranjeeta
a Department of Obstetrics and Gynaecology , AIIMS , Rishikesh , India.
b Department of Community & Family Medicine , AIIMS , Rishikesh , India.
J Obstet Gynaecol. 2019 Aug;39(6):753-756. doi: 10.1080/01443615.2019.1581743. Epub 2019 Apr 22.
Excessive bleeding during and after caesarean section is a major cause of maternal morbidity and mortality, especially in low resource countries. This study evaluates the effect of intrauterine misoprostol with oxytocin in comparison with oxytocin alone on blood loss during caesarean section. A retrospective data analysis of 160 women who underwent lower segment caesarean section was conducted. Eighty-five out of 160 (53%) women received tablet misoprostol 800 µg by intrauterine route after delivery of a baby in addition to routine oxytocin infusion (group A), while 75 women (47%) received only oxytocin (group B). Blood loss, Haemoglobin (Hb) difference (pre-operative Hb - post-operative Hb) and need of any other oxytocic were compared in both the groups. Demographic variables such as mean age, parity, and an indication of caesarean section were comparable in both the groups. Mean blood loss during caesarean section was lower in group A (680 ± 202 mL) than group B (740 ± 228 mL) ( = .08). Higher Hb difference was noted in group B (1.03 ± 0.83 gm%) than group A (0.93 ± 0.68 gm%) ( = .41). No patient required additional oxytocic and no patient had postpartum haemorrhage in both the groups. The use of misoprostol by the intrauterine route in addition to routine oxytocin infusion during caesarean section is associated with a clinically significant reduction in intra-operative and post-operative blood loss. IMPACT STATEMENT The role of misoprostol in the prevention and treatment of haemorrhage during and after caesarean section is well known and well studied. It is a better alternative to oxytocin in low resource settings. Various routes of misoprostol, with or without oxytocin, and its effect on intrapartum and postpartum haemorrhage are described in the literature. Misoprostol is an autocoid substance and acts better if it is close to the target organ (uterus). The use of misoprostol by the intrauterine route during caesarean section has not been well explored. The use of misoprostol by intrauterine route in addition to routine oxytocin infusion during caesarean section is associated with decreased intra-operative and post-operative -blood loss. The findings of this study reveal that misoprostol is also effective by the intrauterine route. It is a convenient way to insert misoprostol during caesarean section and it can be considered to prevent intrapartum and postpartum haemorrhage. More studies including randomised controlled trials with bigger sample size are needed to reach to any firm conclusion.
剖宫产术中及术后出血过多是孕产妇发病和死亡的主要原因，在资源匮乏国家尤其如此。本研究评估了子宫内使用米索前列醇联合缩宫素与单纯使用缩宫素相比，对剖宫产术中失血的影响。对160例行下段剖宫产术的妇女进行了回顾性数据分析。160名妇女中有85名（53%）在胎儿娩出后经子宫内途径接受了800μg米索前列醇片，同时进行常规缩宫素输注（A组），而75名妇女（47%）仅接受缩宫素（B组）。比较了两组的失血量、血红蛋白（Hb）差值（术前Hb - 术后Hb）以及是否需要使用其他宫缩剂。两组的人口统计学变量如平均年龄、产次和剖宫产指征具有可比性。A组剖宫产术中的平均失血量（680±202mL）低于B组（740±228mL）（P = 0.08）。B组的Hb差值（1.03±0.83g%）高于A组（0.93±0.68g%）（P = 0.41）。两组均无患者需要额外使用宫缩剂，也无患者发生产后出血。剖宫产术中除常规缩宫素输注外，经子宫内途径使用米索前列醇与术中及术后失血量的临床显著减少相关。影响声明 米索前列醇在预防和治疗剖宫产术中及术后出血中的作用已广为人知且研究充分。在资源匮乏地区，它是缩宫素的更好替代药物。文献中描述了米索前列醇的各种给药途径（有无缩宫素）及其对产时和产后出血的影响。米索前列醇是一种自体活性物质，如果靠近靶器官（子宫），其作用会更好。剖宫产术中经子宫内途径使用米索前列醇尚未得到充分研究。剖宫产术中除常规缩宫素输注外，经子宫内途径使用米索前列醇与术中及术后失血量减少相关。本研究结果表明，米索前列醇经子宫内途径也有效。在剖宫产术中插入米索前列醇是一种方便的方法，可用于预防产时和产后出血。需要更多研究，包括更大样本量的随机对照试验，才能得出任何确凿结论。
