Buccal misoprostol to prevent hemorrhage at cesarean delivery: a randomized study.
OBJECTIVE
The purpose of this study was to assess the efficacy of buccal misoprostol to decrease uterine atony, hemorrhage, and the need for additional uterotonic agents during cesarean delivery.


METHODS
Patients who underwent cesarean delivery were assigned randomly to either 200-microg misoprostol or placebo placed in the buccal space. A dilute intravenous oxytocin infusion was given to all patients at delivery of the placenta. The primary outcome variable was the need for additional uterotonic agents.


RESULTS
A total of 352 women received random assignments. Demographic and intrapartum characteristics were similar between the groups. More women in the placebo group required 1 additional uterotonic agent (43% vs 26%; P < .01; relative risk, 1.3; 95% CI, 1.10, 1.50). There was not a difference between the groups in the incidence of postpartum hemorrhage or a difference in preoperative and postoperative hemoglobin level.


CONCLUSIONS
Buccal misoprostol reduces the need for additional uterotonic agents during cesarean delivery.
Hamm
Jennifer
J
Arnold Palmer Hospital for Children and Women, Orlando, Fla, USA.
Russell
Zoi
Z
Botha
Tracey
T
Carlan
S J
SJ
Richichi
Kris
K
D000284:Administration, Oral; D002585:Cesarean Section; D002610:Cheek; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D016595:Misoprostol / Q000008:administration & dosage* / Q000627:therapeutic use; D010120:Oxytocics / Q000008:administration & dosage* / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D016896:Treatment Outcome
D010120:Oxytocics; D016595:Misoprostol