title: Sublingual misoprostol to reduce blood loss at cesarean delivery.
abstract: OBJECTIVE
  This prospective randomized controlled study was carried out with the purpose of assessing the efficacy of sublingual misoprostol in decreasing intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
  
  
  METHODS
  One hundred seventy-four women undergoing elective or emergency cesarean delivery were assigned randomly to receive either 400 μg misoprostol or placebo sublingually at the time of cord clamping. An intravenous infusion of 20 units of oxytocin was started in all women at the same time. The primary outcome measures were intraoperative blood loss, need for additional uterotonic agents, and perioperative hemoglobin (Hb) fall.
  
  
  RESULTS
  The maternal demographic factors, indications for cesarean delivery, and high-risk factors were similar between the two groups. Mean intraoperative blood loss was significantly less in misoprostol group as compared with placebo group (595 ± 108 vs. 651 ± 118 ml, P = 0.025). Fewer women needed additional uterotonic agents in misoprostol group (22.2 vs. 42.8 %; P = 0.0035; RR 0.52, 95 % CI 0.33-0.82). Perioperative Hb fall was significantly less in misoprostol group (0.87 ± 0.29 vs. 1.01 ± 0.26 g, P = 0.0018).
  
  
  CONCLUSIONS
  Sublingual misoprostol decreases intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
authors.affiliation: Department of Obstetrics & Gynecology, Armed Forces Clinic, New Delhi, Dalhousie Road, New Delhi, 110011 India.
authors.forename: Atul Kumar
authors.initials: AK
authors.lastname: Sood
authors.forename: Sanjay
authors.initials: S
authors.lastname: Singh
keywords: Blood loss; Cesarean delivery; Sublingual misoprostol
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