الفهرس 
Introduction
History of Cesarean section techniquesOnly 14 pages are availabe for public view
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Abstract
The present study is a prospective, single blinded, randomized clinical trial that was carried out at the Obstetrics and Gynecology department, Woman Health Hospital, Assiut University, Assiut, Egypt.
All pregnant women who would undergo elective lower segment cesarean section at term ( ≥ 37 weeks) with normal fetal heart tracing received written and verbal information about the study and were asked to participate. Those who agreed signed an informed consent form.
A total of 424 women undergoing cesarean section were randomly assigned to preoperative and postoperative sublingual misoprostol (group 1 and group 2 respectively) 213 women in group 1 and 211 women in group 2.
Criteria of exclusion were placenta previa , rupture uterus , classical cesarean section , preterm delivery , hypertensive disorders of pregnancy , bleeding tendency , previous history of PPH , concurrent anticoagulant therapy , concurrent long-term use of steroids , fetal distress and antepartum haemorrhage.
Primary outcome was estimation of intraoperative and postoperative blood loss for 24 hours. Secondary outcomes included changes in hemoglobin concentration , misoprostol-induced maternal adverse effects , need to use other uterotonic drugs , need to do further surgical interventions and need for blood transfusion.
Results:
The current study found that the intraoperative blood loss and postoperative blood loss were significantly lower in the preoperative misoprostol group (group 1) than in postoperative misoprostol group (group 2). Postoperative hemoglobin and hematocrit values were significantly higher in group 1 compared with group 2. There was no significant difference between both groups regarding the rate of intraoperative uterine atony, the need for additional oxytocin or ergometrine , need for blood transfusion. Fever and chills were more frequent in the group 1 than in group 2. The rate of nausea, vomiting and diarrhea was similar in both groups. Duration of the surgery and duration of hospital stay were similar in both groups.
Conclusion:
Preoperative administration of sublingual misoprostol (400 μg) during C.S is better than postoperative administration as it is associated with reduction in the amount of intraoperative and postoperative blood loss, DROP in hemoglobin level is less , incidence of intraoperative uterine atony is lower , the need for uterotonic drugs or blood transfusion is lower , although fever and chills could still happen.
Limitations:
Potential weakness in our study was administration of 20 IU oxytocin after delivery of the fetus in both study groups which could have an influence on intraoperative blood loss.
Also, the study included patients with no risk for PPH and those at risk of PPH ( multiple pregnancy, polyhydraminos , hydrocephalus) who could benefit more from misoprostol.