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Background: Intra-partum and early postpartum blood loss are increased in conjunction with Cesarean delivery. Misoprostol is a potent uterotonic agent that has been extensively studied in the prevention and treatment of PPH after vaginal delivery, however, its use in conjunction with CD has not been investigated as much. Objective: To evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective Cesarean delivery. Materials and methods: A randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. The study group (n=100) received 200 µg of misoprostol. The control group (n=100) received placebo. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values. Results: The mean intra-operative and postpartum blood loss was lower in the study group than the control group: 374 ± 69.9 ml and 131 ± 31.8 ml versus 401 ± 79.9 and 145 ± 35.6 ml, respectively. The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.3 ± 2.26 and 5.25 ± 2.61, p =0.006). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the two groups. Conclusion: Preoperative administration of 200 µg rectal misoprostol significantly reduced blood loss related to elective Cesarean delivery
RESUMO
PURPOSE: Propranolol is known to decrease portal pressure by reducing blood flow of portal vein. Per-rectal portal scintigraphy with Tc-99m pertechnetate has been introduced to evaluate the portal circulation and early diagnosis of liver cirrhosis. We evaluated the effects of propranolol on portal circulation by using per-rectal portal scintigraphy. MATERIALS AND METHODS: We analyzed the portal hemodynamics by per-rectal portal scintigraphy in 51 patients with liver cirrhosis, 10 chronic hepatitis and 10 normal subjects. 38 patients with cirrhosis underwent per-rectal portal scintigraphy before and after propranolol medication. Per-rectal portal scintigraphy was performed after per-rectal administration of 370 MBq of Tc-99m pertechnetate. The shunt index was calculated as the ratio, expressed as a percentage of heart radioactivity to the sum of heart and liver radioactivity during the first 30 seconds. RESULTS: The shunt index in 40 patients with cirrhosis (59.8+/-27.2%) was significantly higher than that of normal control (5.0+/-1.2%, p<0.01) and chronic hepatitis (11.4+/-3.5%, p<0.01). Shunt index was significantly different according to Child's classification and the degree of esophageal varix (p<0.01). After propranolol medication, shunt index was significantly decreased from 59.9+/-27.3% to 51.3+/-15.3% (p<0.01) in 38 patients with liver cirrhosis. There was no significant difference of the amount of shunt index reduction after propranolol according to Childs' classification and the degree of esophgageal varix. CONCLUSION: The effect of propranolol on portal circulation was demonstrated as decreasing shunt index on per-rectal portal scintigraphy in patients with liver cirrhosis. Per-rectal portal scintigraphy may be useful to evaluate the portal circulation and to predict the effect of propranolol in patients with liver cirrhosis.