title: A randomized clinical trial of preoperative versus postoperative misoprostol in elective cesarean delivery.
abstract: OBJECTIVE
  To determine the optimum time for misoprostol administration to minimize blood loss during and after elective cesarean delivery.
  
  
  METHODS
  A randomized clinical trial was conducted at Mansoura University Hospital, Egypt, between January 1, 2013, and December 31, 2014. Eligible participants had full-term pregnancies, were scheduled to have a cesarean, and had normal fetal heart tracing. Patients were randomly allocated into two equal groups using computer-generated tables and sealed opaque envelopes. Misoprostol (400μg, given rectally) was given either before (group 1) or after (group 2) surgery. Patients, investigators, and data analysts were not masked to group assignment. The primary outcome was blood loss.
  
  
  RESULTS
  A total of 348 women were included (174 in each group). Blood loss was significantly lower in group 1 than in group 2 (570±240 vs 844±270mL; P<0.001). The frequency of maternal and neonatal adverse events did not differ between the groups.
  
  
  CONCLUSIONS
  Preoperative misoprostol (400μg, given rectally) reduces blood loss to a greater extent than does postoperative misoprostol during elective cesarean delivery. The frequency of complications was not affected by time of administration.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Mansoura University, Mansoura, Egypt. Electronic address: aragab69@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ragab
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Rafik
authors.initials: R
authors.lastname: Barakat
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraydah, Saudi Arabia; Department of Obstetrics and Gynecology, College of Medicine, University of Bahri Suda, Khartoum, Sudan.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Alsammani
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004534:Egypt; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D010120:Oxytocics / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011184:Postoperative Period; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D057234:Preoperative Period; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: Blood loss; Cesarean delivery; Complications; Misoprostol; Postpartum hemorrhage