Abstract

Background:The misoprostol tablet is very soluble and can be dissolved in 20
minutes when it is put under the tongue a pharmacokinetic study compared the
absorption kinetics of oral, vaginal and sublingual routes of administration of
misoprostol found that sublingual misoprostol has the shortest time to peak
concentration, the highest peak concentration and the greatest bioavailability when
compared to other routes.The aim of the present study was to to improve the
management primary postpartum hemorrhage during and after elective cesarean
section (CS). Patients and methods:This study was carried out on 46 cases admitted
for elective CS at University Hospital. They divided into two groups regarding the
protocol of treatment, was given oxytocin, 10 IU in 250 ml of Normal saline
solution over 10 minutes was administered directly after opening the
uterus.Misoprostol group was given 400 mcg misoprostol plus intra venous
Oxytocin administered directly after opening the uterus. Results: There was
statistical significantly between the two studied groups in hemoglobin and HCT
postoperatively with higher level among intra venous oxytocin plus intra uterine
misoprostol than intra venous oxytocin only group. But regarding preoperative
hemoglobin and HCT, there was no statistically significant difference before and
after treatment. Higher blood loss either intraoperative, postoperative and overall
blood loss on intra venous oxytocin only group than intra venous oxytocin plus
intra uterine misoprostol.There was statistical significantly decrease in both
hemoglobin and HCT postoperatively in the two studied groups but this decrease was
more among intra venous oxytocin only group than intra venous oxytocin plus intra
uterine misoprostol. Conclusion:Intrauterine misoprostol combined with oxytocin
infusion during caesarean section can minimise intraoperative blood loss, avoid
postpartum haemorrhage, and reduce any additional uterotonic medication
requirements.