Optimal dose of misoprostol combined with oxytocin for preventing postpartum hemorrhage in cesarean section: A randomised controlled trial.

Background: The study analyzed an optimal misoprostol dosage in prevention of postpartum hemorrhage (PPH). Also evaluated the side effects that might be related to dose of misoprostol. Material and methods: A randomised study was performed in mothers who received cesarean section. Participants were divided into 3 groups of 400, 600 and 800 μg intrauterine misoprostol insertion combined with oxytocin. Clinical characteristics, laboratory testing and operative data were collected. The primary outcome was the amount of intra-operative blood loss and side effects were assigned as a secondary outcome. Results: There were 357 eligible cases, 119 cases in each group equally. Baseline characteristics were similar in between groups. Higher misoprostol dosage demonstrated lower blood loss. Mean blood loss was 509.1, 465.7 and 441.1 ml in the 400, 600 and 800 μg misoprostol groups respectively which were significant difference (p value 0.027). Post-hoc pairwise t-tests found that 800 μg group diminished blood loss than 400 μg group (p value 0.004). Intra-operative blood loss ≥500 ml occurred less frequently in patients receiving higher misoprostol dosage (p value 0.035). However, PPH was not identified difference between groups (p value 0.707). Nausea and vomiting were complained in less than 1% while none of the cases exhibited shivering. Pyrexia was identified in all groups, however, there was a trend towards lower dosage related to less percentage of pyrexia. Conclusions: Either 400, 600 or 800 μg of misoprostol can prevent PPH similarly. However, the study prefers 400 μg misoprostol because of minimization the side effects.