Prospective Comparison of Rectal Misoprostol versus Oxytocin Infusion for Prevention of Post-Caesarean Section Primary Postpartum Hemorrhage

Background: The drug of choice recommended by the WHO for the prevention of primary postpartum hemorrhage after vaginal or post Caesarean delivery is oxytocin. However, oxytocin is labile in hot tropical climates as in Africa with reduced efficacy. Misoprostol may be an alternative as it has most properties of oxytocin.

Aim: The aim of the study is to compare the efficacy and safety of rectal misoprostol with oxytocin in preventing primary postpartum haemorrhage after Caesarean delivery.

Study Design: This study was a double blind, randomized controlled trial - non-inferior design.

Methodology: One hundred and forty women who were suited for Caesarean delivery were randomly selected into two groups of 70 parturients each. One arm of the study had 40 IU of oxytocin in 1 litre of normal saline and the other arm had 600 ug of rectal misoprostol after Caesarean section, to prevent primary postpartum haemorrhage.

The 24-hours blood loss per vaginam was collected and compared between the study arms, as the primary outcome measure.

Analysis: All data extracted were entered into SPSS version 25.0 and analyzed. The statistical significance was set at p-value of 0.05.

Results: There was no statistically significant difference between the Misoprostol and Oxytocin groups in preventing primary postpartum hemorrhage after Caesarean section. (106.8 ± 48.6 ml vs. 131.7 ± 161.4 ml, p= 0.839).

Conclusion: Rectally administered misoprostol was as effective as oxytocin infusion in the prevention of primary postpartum hemorrhage after vaginal or Caesarean delivery, giving Obstetricians choices of drugs to use.