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Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: A randomized controlled trial


Dr Kola M. Owonikoko, Department of Obstetrics & Gynaecology, Faculty of Health Sciences, Ladoke Akintola University of Technology, PMB 4000, Ogbomoso, Oyo State, Nigeria. Email:


Aims:  The aim of this study was to compare the effectiveness and safety of sublingual misoprostol with i.v. oxytocin infusion administered after delivery in reducing blood loss at cesarean section in Nigeria.

Materials and Methods:  One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia in Nigeria were randomly allocated to receive either misoprostol 400 µg sublingually or i.v. infusion of 20 units oxytocin soon after delivery of the baby. Estimated blood loss at surgery and within the first 4 h post-operation were measured in both groups.

Results:  No significant difference was found in mean blood loss between the oxytocin and misoprostol groups. Similarly, no significant difference occurred between preoperative and postoperative hematocrit levels in both groups. The need for additional oxytocin was similar in both groups. There was significantly less blood loss in the first 4 h after surgery in the misoprostol group than in the oxytocin group (58.2 ± 20.7 vs 80.5 ± 26.8; P-value = 0.02). The incidence of adverse effects like shivering/pyrexia was significantly higher in the misoprostol group than in the oxytocin group (27/50 vs 1/50, P < 0.001).

Conclusion:  Sublingual misoprostol was as effective as i.v. oxytocin infusion in reducing blood loss at cesarean section. It offers several advantages over oxytocin, including long shelf life, stability at room temperature, and oral administration, which make it a suitable uterotonic agent in low-resource areas.