title: Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: A randomized clinical trial.
abstract: OBJECTIVE
  This study compares the efficacy of sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery.
  
  
  METHODS
  A randomized clinical trial conducted on 120 pregnant women at term (37-40 weeks) gestation scheduled for elective cesarean delivery, who were assigned to either sublingual misoprostol 400 μg or intravenous infusion of 20 units of oxytocin after delivery of the neonate. The main outcome measures were blood loss at and 2 hours after cesarean delivery, change in hematocrit value, need for any additional oxytocic drugs, and drug-related side effects.
  
  
  RESULTS
  The overall mean blood loss was significantly lower in the misoprostol group compared to the oxytocin group (490.75 ± 159.90 mL vs. 601.08 ± 299.49 mL; p = 0.025). However, changes in hematocrit level (pre- and postpartum) was comparable between both groups. There was a need for additional oxytocic therapy in 16.7% and 23.3% after use of misoprostol and oxytocin, respectively (p = 0.361). Incidence of side effects such as shivering and metallic taste were significantly higher in the misoprostol group compared to the oxytocin group (p < 0.001).
  
  
  CONCLUSIONS
  Sublingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss during and after cesarean delivery. However, occurrence of temporary side effects such as shivering and metallic taste was more frequent with the use of misoprostol.
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Essam Rashad
authors.initials: ER
authors.lastname: Othman
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Margaret Fathy
authors.initials: MF
authors.lastname: Fayez
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Diaa Eldeen Mohamed Abd
authors.initials: DE
authors.lastname: El Aal
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Hazem Saad
authors.initials: HS
authors.lastname: El-Dine Mohamed
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Ahmed Mohammed
authors.initials: AM
authors.lastname: Abbas
authors.affiliation: Woman's Health Hospital, Assiut University, Assiut, Egypt. Electronic address: m_khairy2001@yahoo.com.
authors.forename: Mohammed Khairy
authors.initials: MK
authors.lastname: Ali
mesh_terms: D061605:Administration, Intravenous; D000286:Administration, Sublingual; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage* / Q000009:adverse effects; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D047929:Term Birth; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin
keywords: misoprostol; oxytocin; postpartum hemorrhage