Comparison of the effects of intrauterine and rectal misoprostol on postpartum hemorrhage

Aim: In this study, we aimed to compare the success of oxytocin alone, intracavitary misoprostol and rectal misoprostol in preventing postpartum hemorrhage. Method: 150 patients who were at high risk for postpartum hemorrhage and scheduled for cesarean delivery between July 1, 2023 and January 1, 2024 at Van Yüzüncü Yıl University Dursun Odabaşı Medical Center, Department of Obstetrics and Gynecology, Obstetrics Clinic were included in this prospective randomized controlled study. Patients were randomized equally into three groups: oxytocin only (Group-1), oxytocin plus rectal misoprostol (Group-2), and oxytocin plus intracavitary cornual misoprostol (Group-3). The groups were compared in terms of preoperative, intraoperative and postoperative demographic, laboratory and bleeding characteristics. Results: There was no statistically significant difference between the groups in terms of age; obstetric history; preoperative blood pressures, hemoglobin and hematocrit values, leukocyte counts and intraoperative pad counts (p>0.05). Hemoglobin and hematocrit levels recorded at postoperative 4th hour, 24th hour and 10th day were statistically significantly higher in Group-2 and Group-3 compared to Group-1 (p<0.001). Compared with Group-1, the number of intraoperative sponges and the mean volume of intracavitary fluid localization were statistically significantly lower in the other two groups (p<0.001). The number of intraoperative sponge sheets and the mean volume of intracavitary fluid localization were statistically significantly less in Group-3 than in Group-2 (p<0.001). Conclusion: Intrauterine cornual misoprostol administration in addition to oxytocin in cesarean deliveries at high risk for postpartum hemorrhage may lead to better outcomes in the risk and incidence of postpartum hemorrhage Keywords: Postpartum hemorrhage, oxytocin, rectal misoprostol, intrauterine misoprostol