title: The Effect of Combined Oxytocin-Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study.
abstract: OBJECTIVE
  To compare the effect of combined oxytocin-misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery.
  
  
  METHODS
  One hundred fifty patients of 18-40 years with singleton term pregnancies scheduled for cesarean section under spinal anesthesia were recruited in a prospective double-blind randomized clinical trial to one of the three following groups to receive 20 IU infusion of oxytocin (group O), 400-µg sublingual misoprostol tablets (group M) or 200-µg misoprostol plus 5 IU bolus intravenous oxytocin (group MO) after delivery. The hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded.
  
  
  RESULTS
  The mean blood loss during surgery was significantly lower in group MO compared to other groups (P = 0.04). Comparison of mean arterial pressure (P = 0.38) and heart rate (P = 0.23) changes during spinal anesthesia and surgery failed to reveal any statistically significant differences between all groups through repeated measure analysis.
  
  
  CONCLUSIONS
  The use of combined lower dose of misoprostol-oxytocin significantly reduced the amount of blood loss during and after the lower segment cesarean section compared to higher dose of oxytocin and misoprostol alone, and its use was not associated with any serious side effects.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Shahid Bahonar Ave., PO Box 3419759811, Qazvin, Iran.
authors.forename: Hamideh
authors.initials: H
authors.lastname: Pakniat
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Qazvin University of Medical Science, Shahid Bahonar Ave., PO Box 3419759811, Qazvin, Iran.
authors.forename: Marzieh Beigom
authors.initials: MB
authors.lastname: Khezri
keywords: Blood loss; Cesarean; Misoprostol; Oxytocin; Oxytocin postpartum hemorrhage; Spinal anesthesia