Comparison of Mean Blood Loss in Cesarean Delivery Treated with Combined Oxytocin Misoprostol Versus Oxytocin Alone

Authors

  • Ayesha Iftikhar Department of Gynecology and Obstetrics, Faisalabad Medical University, Faisalabad, Pakistan.
  • Shazia Shaheen Department of Gynecology and Obstetrics, Faisalabad Medical University, Faisalabad, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.1965

Keywords:

Cesarean delivery, postpartum hemorrhage, oxytocin, misoprostol, blood loss, uterotonic agents

Abstract

Objectives: To compare the mean blood loss in cesarean deliveries treated with combined intravenous oxytocin and sublingual misoprostol versus oxytocin alone. Study Settings: Department of Obstetrics and Gynecology, Allied Hospital, Faisalabad. Duration of Study: Following approval from the College of Physicians and Surgeons Pakistan (CPSP). Data Collection: A randomized controlled trial was conducted involving 228 term pregnant women undergoing cesarean section. Participants were randomly allocated into two groups: Group A received 200 µg misoprostol plus 5 IU IV oxytocin, and Group B received oxytocin alone (5 IU IV bolus followed by 15 IU infusion). Blood loss was estimated using hematocrit changes measured pre- and 24 hours postoperatively. Results: The mean blood loss was lower in Group A (235.55 ± 99.27 mL) compared to Group B (263.91 ± 139.17 mL) (p = 0.078). Among patients with BMI >25 kg/m², the reduction in blood loss in Group A was statistically significant (p = 0.008). No significant differences were observed in hemoglobin or hematocrit levels between the groups overall. Conclusion: The combination of misoprostol and oxytocin during cesarean section is associated with reduced blood loss compared to oxytocin alone, particularly in women with elevated BMI. This synergistic approach may offer clinical benefits in high-risk populations.

Downloads

Download data is not yet available.

References

1. Kolin DA, Shakur-Still H, Bello A, Chaudhri R, Bates I, Roberts I. Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials. PLoS One. 2020;15(6):e0233274.

https://doi.org/10.1371/journal.pone.0233274

2. Sighaldeh SS, Nazari A, Maasoumi R, Kazemnejad A, Mazari Z. Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul- Afghanistan. BMC Pregnancy Childbirth. 2020;20(1):1–9.

https://doi.org/10.1186/s12884-020-03123-3

3. Alejandra GCL, Angel RZM, Lisbeth KGJ. Postpartum Hemorrhage: Risk Factors and Preventive Strategies. J Gynecol Obstet. 2021;9:200–5.

https://doi.org/10.11648/j.jgo.20210906.13

4. Hancock A, Weeks AD, Tina LD. Assessing blood loss in clinical practice. Best Pract Res Clin Obstet Gynaecol. 2019;61:28–40.

https://doi.org/10.1016/j.bpobgyn.2019.04.004

5. Shaheen N, Khalil S. Safety and efficacy of 600 ug sublingual Misoprostol versus 10 U intramuscular Oxytocin for management of third stage of labor. Rawal Med J. 2019;44(1):137.

6. Ottun TA, Adewunmi A, Rabiu AK, Olumodeji AM, Oladipo OM, Olalere HF. Misoprostol and oxytocin versus oxytocin alone in the active management of the third stage of labour: a randomised, double-blind, placebo-controlled trial. J Obstet Gynaecol. 2022;42(5):1048–53.

https://doi.org/10.1080/01443615.2021.1995342

7. Bahadur A, Khoiwal K, Bhattacharya N, Chaturvedi J, Kumari R. The effect of intrauterine misoprostol on blood loss during caesarean section. J Obstet Gynaecol. 2019;39(6):753–6.

https://doi.org/10.1080/01443615.2019.1581743

8. Ghada Abd Al RA, Al-Noor II, Halim HW. Comparison between using intrauterine misoprostol with oxytocin infusion and oxytocin alone in reduction of blood loss in cesarean delivery. Sci J Al-Azhar Med Fac Girls. 2021;5(1):158–62.

https://doi.org/10.4103/sjamf.sjamf_110_20

9. Pakniat H, Khezri MB. The effect of combined oxytocin–misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery: a prospective randomized double-blind study. J Obstet Gynecol India. 2015;65:376–81.

https://doi.org/10.1007/s13224-014-0607-3

10. Mumtaz J, Gull R, Asghar S, Naheed S, Nadeem A, Saleem A. Comparison of preoperative misoprostol versus standard active management in minimizing blood loss during elective caesarean section. J Popul Ther Clin Pharmacol. 2025;32(5):204–11.

https://doi.org/10.53555/8rxxb473

11. Ibrahim RA. Combined use of misoprostol plus oxytocin versus oxytocin alone to reduce blood loss during cesarean section. Egypt J Hosp Med. 2022;88:3299–303.

https://doi.org/10.21608/ejhm.2022.248113

12. Atef A, Shehata HS, Bassiouny YA, Al-Inany HG. Comparative study between the roles of intrauterine misoprostol versus the sublingual route for prevention of postpartum blood loss in elective cesarean sections: a randomized controlled trial. BMC Pregnancy Childbirth. 2024;24:710.

https://doi.org/10.1186/s12884-024-06889-y

13. Maqsood M, Maqsood S, Nasir K, Zafar H, Saeed F, Waheed I. Compare the mean blood loss during a term caesarean delivery in primigravidas using sublingual misoprostol with an intravenous oxytocin infusion. J Pak Soc Intern Med. 2022;3(4):324–7.

https://doi.org/10.70302/jpsim.v3i4.2263

14. Selvaraj A, Subramanian K, Periyasamy S, Shankar R. A comparative study between misoprostol combined with oxytocin versus oxytocin alone in reducing postpartum blood loss. J Med Sci Res. 2024;12(1):57–61.

https://doi.org/10.17727/jmsr.2024/12-10

15. Fatima N, Kanwal T, Choudhary SA, Zia S, Iram H, Saleem L. Intravenous oxytocin versus oxytocin combined with misoprostol in the management of the third stage of labor in vaginal delivery. Pak J Med Health Sci. 2023;17(4):614–5.

https://doi.org/10.53350/pjmhs2023174614

16. Mube WA, Gbaranor KB, Ozims SJ, Eberendu IF, Olaka EW, Ikpeazu O, Nwogu HC. Comparative study of adjunct misoprostol and oxytocin versus oxytocin alone on side effects profile and need for additional uterotonics in the prevention of postpartum hemorrhage. Int J Clin Med Case Rep. 2023;36(1):004.

https://doi.org/10.46998/ijcmcr.2023.36.000879

Downloads

Published

2025-07-20

How to Cite

Iftikhar, A., & Shaheen, S. (2025). Comparison of Mean Blood Loss in Cesarean Delivery Treated with Combined Oxytocin Misoprostol Versus Oxytocin Alone. Indus Journal of Bioscience Research, 3(7), 525-528. https://doi.org/10.70749/ijbr.v3i7.1965