Sadeghi Afkham Mansoureh, Hashemnejad Maryam, Esmaelzadeh Saeieh Sara, Ataei Mina, Valizadeh Rohollah
Clinical Research Development Center of Kamali Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Department of Obstetrics and Gynecology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Ann Med Surg (Lond). 2022 Jul 20;80:104175. doi: 10.1016/j.amsu.2022.104175. eCollection 2022 Aug.
Postpartum hemorrhage is one of the three major causes of maternal morbidity and mortality, so delay in the diagnosis and proper management of postpartum hemorrhage is of great importance. The present study aimed to determine the prophylactic effect of misoprostol on postpartum hemorrhage in patients with preeclampsia.
This was a double-blind randomized controlled clinical trial performed on 128 pregnant women with preeclampsia undergoing cesarean section in Kamali hospital in Karaj. After cesarean delivery, immediately after clamping the umbilicus, the first group was administered 400 μg of rectal misoprostol and the second group was given 400 μg of sublingual misoprostol. The third group (control) was given 30 units of oxytocin during surgery and within 12 h after surgery, respectively. Hemoglobin and hematocrit were measured 24 h later. The estimated bleeding rate by the physician, the need for additional medication to control bleeding, and the amounts of hemoglobin and hematocrit in the first 24 h were compared in the three groups. Finally, the obtained information was entered into SPSS version 21 and analyzed using statistical tests.
The mean hemoglobin and hematocrit levels 6 and 12 h after cesarean section were significantly lower in the oxytocin group than in the sublingual and rectal misoprostol groups (Hemoglobin level (mg/dl) for oxytocin group 10.39 ± 0.73 and 9.53 ± 1.09 vs. sublingual misoprostol 11.05 ± 0.71 and 10.39 ± 0.84 vs. rectal misoprostol 10.92 ± 0.85 and 10 ± 1.01; hematocrit level for Hemoglobin level (%) for oxytocin group 31.27 ± 2.29 and 28.64 ± 2.93 vs. sublingual misoprostol 33.09 ± 2.20 and 31.05 ± 2.37 vs. rectal misoprostol 32.54 ± 2.7 and 29.92 ± 2.86) (p < 0.005). The mean estimation of visual bleeding in the oxytocin group was higher than the other three groups, followed by the rectal and the sublingual groups, respectively. However, there was no significant difference between the three groups regarding visual bleeding. There was no significant difference in hemoglobin and hematocrit between the two groups of sublingual and rectal misoprostol before and 6 and 12 h after the surgery (P > 0.05).
It seems that sublingual or rectal misoprostol administration along with oxytocin is associated with a reduction in postpartum cesarean section bleeding compared to oxytocin administration alone.
产后出血是孕产妇发病和死亡的三大主要原因之一，因此产后出血的诊断延迟和妥善处理至关重要。本研究旨在确定米索前列醇对先兆子痫患者产后出血的预防效果。
这是一项双盲随机对照临床试验，对在卡拉季卡马利医院接受剖宫产的128例先兆子痫孕妇进行。剖宫产术后，在钳夹脐带后立即给第一组直肠给予400μg米索前列醇，第二组舌下给予400μg米索前列醇。第三组（对照组）在手术期间和术后12小时内分别给予30单位缩宫素。24小时后测量血红蛋白和血细胞比容。比较三组医生估计的出血量、控制出血所需额外用药情况以及术后24小时内的血红蛋白和血细胞比容水平。最后，将获得的信息录入SPSS 21版并使用统计检验进行分析。
缩宫素组剖宫产术后6小时和12小时的平均血红蛋白和血细胞比容水平显著低于舌下和直肠米索前列醇组（缩宫素组血红蛋白水平（mg/dl）为10.39±0.73和9.53±1.09，舌下米索前列醇组为11.05±0.71和10.39±0.84，直肠米索前列醇组为10.92±0.85和10±1.01；缩宫素组血细胞比容水平（%）为31.27±2.29和28.64±2.93，舌下米索前列醇组为33.09±2.20和31.05±2.37，直肠米索前列醇组为32.54±2.7和29.92±2.86）（p<0.005）。缩宫素组目测出血量的平均值高于其他三组，其次分别是直肠组和舌下组。然而，三组之间在目测出血量方面无显著差异。舌下和直肠米索前列醇两组在手术前以及术后6小时和12小时的血红蛋白和血细胞比容无显著差异（P>0.05）。
与单独使用缩宫素相比，舌下或直肠给予米索前列醇联合缩宫素似乎可减少剖宫产术后出血。
