Intrauterine vs. Sublingual Misoprostol Routes Compared for Postpartum Blood Loss Prevention in Elective Cesarean Sections

Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, with uterine atony being the primary cause. Current standard-of-care often involves oxytocin, but its efficacy can be limited, and alternative uterotonics are crucial, especially in resource-limited settings or for patients unresponsive to oxytocin. Misoprostol, a synthetic prostaglandin E1 analog, offers a stable, inexpensive, and effective option for PPH prevention due to its uterotonic properties, but optimal routes of administration are still being investigated to maximize bioavailability and minimize side effects. This study directly compares two common routes.

This prospective randomized controlled trial enrolled 192 pregnant women (aged 20-35 years, BMI <30 kg/m2) undergoing elective cesarean delivery at Kasr Al Aini Hospital. Participants had a full-term singleton healthy fetus and a history of one or two previous C-sections. Exclusions included uterine overdistension, high parity, fibroids, antepartum hemorrhage, anemia (Hb <9mg/dl), coagulopathy, or contraindications to prostaglandins. The study compared intrauterine versus sublingual administration of Misoprostol for PPH prevention, with primary endpoints likely focused on blood loss measurements.