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BMC Pregnancy and Childbirth (2023) 23:611 BMC Pregnancy and Childbirth
https://doi.org/10.1186/s12884-023-05935-5
Abstract
Objective This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to
that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women
for postpartum haemorrhage (PPH) following cesarean section (CS).
Methods About 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly
assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication
given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding
intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values.
Results Both tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood
loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol
groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P < 0.001 and − 3.05 ± 1.28 vs.
-3.06 ± 1.13 vs. -4.94 ± 1.82%, P < 0.001 respectively). In addition, the estimated blood loss was significantly lower in the
tranexamic and misoprostol groups compared to the control group (641.6 ± 271.9 vs. 617.9 ± 207.4 vs. 1002.4 ± 340.7
ml, P < 0.001).
Conclusion Both tranexamic acid and misoprostol are equally capable of reducing blood loss, but the results were
significantly better compared to using oxytocin alone in high-risk patients.
Clinical Trial Registration Registered at www.clinicaltrials.govon07/10/2019 with registration number
NCT04117243.
Keywords Misoprostol, Oxytocin, Postpartum haemorrhage, Tranexamic acid
*Correspondence:
Mazen Abdel-Rasheed
doctor_mazen@hotmail.com
1
Obstetrics and Gynaecology Department, Faculty of Medicine, Cairo
University, Cairo, Egypt
2
Reproductive Health Research Department, National Research Centre, 33
El-Buhouth St, Dokki, 12622 Cairo, Egypt
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Dawoud et al. BMC Pregnancy and Childbirth (2023) 23:611 Page 2 of 7
thromboembolism. Yet, the authors had safety concerns Majumdar (2015) studied the effect of sublingual miso-
over the use of tranexamic acid. They explained that the prostol in a dose of 400 mcg versus placebo in 198
trial was of moderate quality [20]. women undergoing emergency CS and at high risk for
Regarding the role of adding sublingual misoprostol to blood loss. In their study, misoprostol was given follow-
oxytocin in preventing PPH, previous studies revealed ing delivery of the baby, unlike in our study, in which
similar results to our findings [21, 22]. Chaudhuri and misoprostol was given before skin incision. They also
Dawoud et al. BMC Pregnancy and Childbirth (2023) 23:611 Page 5 of 7
Acknowledgements
used 20 U of oxytocin IV following delivery of the baby None.
in both groups, whereas we used 10 U of oxytocin. The
misoprostol group showed a significantly lower mean Authors’ contributions
O.H. and M.E. designed and supervised the study. M.D., M.A., and M.S.
intraoperative blood loss compared to the placebo group; conducted the study. M.A.R. analyzed the data. All authors wrote and
however, the post-operative blood loss was slightly lower approved the manuscript.
in the misoprostol group. Side effects such as shivering
Funding
and pyrexia were reported more in the misoprostol group This research received no specific grant from any funding agency.
[21]. Open access funding provided by The Science, Technology & Innovation
In a former study, Fekih et al. (2009) compared the Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank
(EKB).
role of sublingual misoprostol administration (in a dose
of 200 mcg) at cord clamping together with oxytocin at Data availability
a dose of 20 U (10 U bolus dose and 10 U infusion in 500 The data that support the findings of this study are available from Kasr El-Ainy
Hospital, but restrictions apply to the availability of these data, which were
ml lactated Ringer), with that of giving oxytocin alone at used under license for the current study, and so are not publicly available.
the same dose in 250 low-risk women undergoing elec- Data are, however, available from the authors upon reasonable request and
tive CS. The combined misoprostol and oxytocin group with permission of Kasr El-Ainy Hospital.
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