An Observational Study to Compare Effectiveness of Preoperative Per Rectal Misoprostol with Non-Misoprostol Group for Preventing Blood Loss in Elective Caesarean Delivery in Tertiary Care Centre

Background: Postpartum haemorrhage remains a major cause of maternal morbidity and mortality worldwide, particularly following caesarean delivery. Misoprostol, a synthetic prostaglandin E1 analogue, has been investigated as an adjunct uterotonic agent for reducing perioperative blood loss during caesarean section. The current study sought to assess the impact of preoperative per rectal misoprostol on postoperative haematological parameters, the need for additional uterotonics, blood transfusions, neonatal outcomes, and maternal adverse effects in addition to comparing its efficacy in reducing blood loss during elective caesarean delivery with a non-misoprostol group. Material and Methods: From January 2025 to January 2026, the Department of Obstetrics and Gynaecology at the Government RDBP Jaipuria Hospital in Jaipur hosted this hospital-based observational study. A control group (n = 30) received normal care without misoprostol, while the misoprostol group (n = 30) received 400 μg rectal misoprostol following spinal anaesthesia. Sixty women undergoing elective lower segment caesarean sections were recruited and divided into two groups. Intraoperative and postoperative blood loss, haematological parameters, requirement for additional uterotonics, blood transfusion, neonatal outcomes, and adverse effects were evaluated. Results: The groups' baseline obstetric and demographic features were similar. The misoprostol group demonstrated significantly lower intraoperative blood loss (345.6 ± 62.3 ml vs. 408.7 ± 71.5 ml; p=0.001), postoperative blood loss (112.4 ± 18.9 ml vs. 139.6 ± 23.7 ml; p=0.003), and total blood loss (458.0 ± 75.2 ml vs. 548.3 ± 89.4 ml; p=0.001). The misoprostol group's postoperative haemoglobin levels were considerably higher (10.2 ± 0.8 g/dL vs. 9.3 ± 1.1 g/dL; p=0.002), whereas their haemoglobin and hemocrit values declined less. The requirement for additional uterotonics and blood transfusion was lower among women receiving misoprostol. Neonatal outcomes were comparable between groups. Shivering and pyrexia were the most common adverse effects but were mild and self-limiting. Conclusion: During elective caesarean sections, preoperative injection of 400 μg rectal misoprostol is a safe and effective adjuvant that reduces perioperative blood loss with positive outcomes for both mothers and newborns.

Keywords: Caesarean section; Misoprostol; Postpartum haemorrhage; Blood loss; Uterotonic agents.