Résumé
Background: The objective of the present study was to compare the efficacy of intrauterine misoprostol with intravenous oxytocin infusion in reducing blood loss during and after cesarean section (CS).Methods: An open, randomized, clinical trial, registered (ClinicalTrials.gov ID: NCT03148574) conducted between July 1, 2017 and April 1, 2018. The study included 240 pregnant females that were recruited at term (37-40 weeks) gestation scheduled for either elective or emergency CS. Eligible participants were randomly allocated into two equal groups: Group A: patients who receive intravenous infusion of 10 I.U diluted to 500ml of normal saline for 30 minute after delivery. Group B: patients received 400μg misoprostol intrauterine just after cord clamping and delivery of the placenta. Primary outcome measure was assessment of amount of intraoperative and postoperative blood loss.Results: The intraoperative and 2h postoperative blood loss in the misoprostol group was higher than oxytocin group (p<0.001). Hemoglobin level decreased significantly among both groups, manifested by the highly significant p value in comparison of pre and postoperative Hb level in the two groups (p<0.001). However, the blood loss in the misoprostol group was higher than oxytocin group (p=0.004). There was a statistical significant differences between both groups as regards the need for additional uterotonic drug (66% in misoprostol group vs 5% in oxytocin group, P<0.001). Shivering and pyrexia were more in common in the misoprostol group while vomiting, headache and giddiness were significantly higher among oxytocin group.Conclusions: Administration of misoprostol 400mcg through intrauterine route appears to be less effective than intravenous oxytocin infusion in reducing blood loss during and after CS.
Résumé
Placenta accreta is a potentially life-threatening obstetric condition that required multidisciplinary approach to management. Placenta accreta occurs in complete absence of the decidua basalis. Women with previous cesarean section delivery or placenta previa are known to be at greater risk of placenta accreta. A previous study reported that 24%& 67% increase in the incidence of placenta accreta in women 1 versus 3 or more previous cesarean deliveries respectively. Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. In practice, incomplete non-separation of the placenta at delivery leads to massive obstetric hemorrhage resulting in maternal morbidities such as massive blood transfusion, DIC, injury to the bladder and intestines and the need for hysterectomy. Sonographic examination with gray scale and color doppler imaging is the recommended first line modality for diagnosis of morbidly adherent placenta. Techniques developed for conservative management are techniques developed to preserve uterus and future fertility which is crucially linked to societal status and self-esteem.