Active management of the third stage at Caesarean section: a randomised controlled trial of misoprostol versus Syntocinon

Authors

  • AU Lokugamage,

    Corresponding author
    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
      2 University College London Gower Street Campus 86–96 Chenies Mews London WC1E 6HX United Kingdom
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  • M Paine,

    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
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  • K Bassaw-Balroop,

    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
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  • KR Sullivan,

    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
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  • H El Refaey,

    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
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  • CH Rodeck

    1. Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, University College London, London, United kingdom
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  • AU Lokugamage Specialist Registrar/Honorary Lecturer, M Paine Senior House Officer, K Bassaw-Balroop Visiting Registrar, KR Sullivan Senior Lecturer, H El Refaey Senior Lecturer, CH Rodeck Professor and Head of Department

2 University College London Gower Street Campus 86–96 Chenies Mews London WC1E 6HX United Kingdom

SUMMARY

The objective of this trial was to investigate whether 500 ug oraJ misoprostol given immediately after delivery of the neonate at Caesarean section is as effective as a bolus intravenous injection of 10 iu Syntocinon in stimulating uterine contractions and thereby reducing blood loss.

Forty women undergoing elective or emergency Caesarean section were included in a placebo-controlled randomised trial.

Group 1 received oral misoprostol and a placebo intravenous bolus and Group 2 received intravenous Syntocinon and oral placebo tablets.

The main outcome measures were estimated blood loss at Caesarean section, drop in serum haemoglobin, and the need for additional uterotonic agents.

We found that there was no significant difference (p = 0.75) in estimated blood loss between the two groups. No differences were observed in the decrease in haemoglobin, requirement for additional oxytocics, the need for blood transfusion or the degree of shivering in each group (p > 0.05 in each case).

We concluded that oral misoprostol could be used as an alternative oxytocic agent for the third stage at Caesarean section. However, there is an obvious need for a larger randomised controlled trial to be undertaken. Previous published studies have concentrated on vaginal births and further studies should be extended to Caesarean deliveries.

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