Background: In low-resource regions of world, misoprostol, with or without oxytocin, has recently emerged as an effective substitute for oxytocin for preventing postpartum hemorrhage by reducing intraoperative and postoperative blood loss (PPH). This study aimed to compare intrauterine misoprostol plus oxytocin effects versus oxytocin only in prevention of primary postpartum hemorrhage.

Subjects and methods: This double-blinded randomized controlled clinical trial involved 94 cases admitted for elective cesarian section at Zagazig University Maternity Hospital. Group (A): 47 pregnant women who received only 20 IU intravenous oxytocin in 500 mL of normal saline solution (infused at a rate of 125 mL/hour) immediately after delivery of the fetus. Group (B): 47 pregnant women who received 20 IU intravenous oxytocin added to 500 mL of normal saline solution (with an infusion rate of 125 mL/hour) immediately after fetal delivery plus intrauterine misoprostol tablets (800mcg) intrauterine after placental delivery. The amount of intra-operative post-operative blood loss and occurrence of PPH were assessed.

Results: The blood loss differed significantly between both groups (P<0.001), with higher blood loss either intraoperative, postoperative, and total blood loss in Group A (Mean + SD 85.1+8.6) than in Group B (Mean + SD 62.3+9.1). Hemoglobin and HCT differed significantly between both groups postoperatively in two studied groups (p=0.045 for each), which was more among Group A (Mean + SD 10.07+0.77) than Group B (Mean + SD 10.37+0.65).

Conclusion: Reduced intraoperative blood loss and prevention of primary postpartum hemorrhage could be achieved by intrauterine misoprostol combined with oxytocin infusion during cesarean section