Comparison of the Effects of Intrauterine and Rectal Misoprostol Combined with Oxytocin Versus Oxytocin Alone on Postpartum Hemorrhage: A Randomized Controlled Trial

Abstract

Background: This study aimed to compare the effects of intrauterine and rectal misoprostol administration in addition to oxytocin, versus oxytocin alone, in preventing postpartum hemorrhage (PPH). Methods: A total of 150 patients scheduled for cesarean delivery and considered at risk for PPH were included in the study. The patients were divided equally into 3 groups: those who received only oxytocin (Group 1), those who received rectal misoprostol in addition to oxytocin (Group 2), and those who received intrauterine (cornual) misoprostol along with oxytocin (Group 3). The groups were compared in terms of demographic, preoperative, intraoperative, and postoperative characteristics, laboratory findings, amount of intrauterine fluid, and infection parameters. Results: No statistically significant differences were observed between the groups in terms of age, obstetric history, preoperative hemoglobin (Hb) and hematocrit (Htc) values, systolic-diastolic blood pressures, and intraoperative pad counts (P > .05). Hb and Htc levels recorded at postoperative 4th and 24th hours, and 10th day were statistically significantly higher in Groups 2 and 3 compared with Group 1 (P < .001). While the total aspirator fluid (TAF) amount was similar between Groups 1 and 2, the TAF amount was statistically lower in Group 3 (P < .01). The number of intraoperative sponges and the mean volume of intracavitary fluid loculation were statistically significantly lower in Groups 2 and 3 compared with Group 1 (P < .01). Intraoperative sponge count and mean intracavitary fluid loculation volume in Group 3 were statistically significantly lower than in Group 2 (P < .01). No difference was observed between mean white blood cell values, and no statistically significant difference was observed between mean C-reactive protein (CRP) values preoperatively and 24 hours postoperatively. On the 10th postoperative day, the mean CRP value in Group 3 was statistically lower than in Group 1 (P = .06). Conclusion: In cesarean deliveries with high risk of PPH, the addition of intrauterine (cornual) misoprostol to oxytocin administration may provide better outcomes in terms of reducing postpartum bleeding and infection risk.