Abstract: Background: Postpartum haemorrhage (PPH) after lower segment caesarean section (LSCS) remains a major cause of maternal morbidity. Misoprostol (PGE?) is a low-cost uterotonic that may reduce blood loss when used prophylactically.
Aim: To evaluate the effect of prophylactic sublingual PGE? during LSCS on blood loss and haemoglobin change.
Methods: In this prospective comparative study at Rangnath Hospital, Kolhapur, 62 women undergoing LSCS were enrolled: 31 received prophylactic sublingual PGE? in addition to standard uterotonics, and 31 received standard uterotonics alone. Primary outcomes were estimated intraoperative blood loss and haemoglobin drop (preoperative to immediate postpartum). Secondary outcomes were the need for additional uterotonics, blood transfusion, and maternal adverse effects. Group differences were analysed using t-tests and chi-square/Fisher’s exact tests.
Results: Baseline maternal and obstetric characteristics were similar between groups (all p>0.05). Mean blood loss was significantly lower with PGE? (486.5±87.8 mL) than in controls (643.6±88.5 mL; p = 2.36 × 10??). Mean haemoglobin drop was also reduced (0.63±0.29 g/dL vs 1.27±0.43 g/dL; p = 6.08 × 10??). Additional uterotonics were required in 6.5% vs 22.6% (p = 0.149), and blood transfusion in 3.2% vs 16.1% (p = 0.195; odds ratio ? 0.17) in the PGE? and control groups, respectively. Fever, shivering and mild gastrointestinal symptoms were more frequent with PGE? but were self-limiting and not significantly different between groups.
Conclusion: Prophylactic sublingual PGE? during LSCS significantly reduces intraoperative blood loss and postpartum haemoglobin fall, with an acceptable adverse-effect profile, and may be a useful adjunct for PPH prophylaxis in caesarean deliveries.
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