Comparative Study of Sublingual versus Rectal Route of Misoprostol Administration in Prevention of Primary Post-partum Haemorrhage in Women with Risk Factors in ESUT Teaching Hospital, Enugu, Nigeria

Abstract

Background: Post-partum haemorrhage is a major cause of maternal death globally but more in low-income countries. While various studies recognized the efficacy of misoprostol in decreasing intraoperative blood loss, there is no consensus on the most effective route of administration of misoprostol.

Objective: This study compared the effect of sublingual misoprostol with rectal misoprostol in preventing primary post-partum haemorrhage in women with risk factor(s) to PPH.

Methodology: This is a comparative study that involved 200 participants who were randomized to two groups by 1:1 computer-based randomization (group A & group B). Each participant in group A received a 600mcg sublingual misoprostol plus rectal placebo, and participants in group B received a 600mcg rectal misoprostol plus sublingual placebo after delivery. The delivery mat already in use and soaked with liquor was removed once delivery was imminent, a new pre-weighed mat was replaced under the patient's buttocks, and also a pre-weighed sanitary pad was placed in her vulva to collect all the blood loss. The need for additional uterotonics and blood transfusion was assessed, and findings were documented appropriately in the proforma. Blood loss throughout a period of 24 hours after the delivery was measured by the gravimetric method. Weight gain from the sanitary pad/ delivery mat was calculated as 1g = 1 ml. The sanitary pad/mat was weighed in triplicate, and the mean of the three weights was entered into the database. The difference was the amount of blood loss, assuming 1g to be equivalent to 1 ml of blood.

Result: The median 24-hour post-partum blood loss was less in sublingual group when compared with the rectal group (110ml vs 170ml) P=0. 001.The mean post-partum Hb was higher in sublingual group 10.00±1.21 vs 9.00± 0.61 P=0.30. Both sublingual and rectal routes of misoprostol administration were effective in preventing PPH, P-value=1.0 and there was no indication for extra-uterotonic or blood transfusion.

Conclusion: It is concluded that even though sublingually and rectally administered misoprostol showed equal efficacy in preventing PPH, sublingual route is associated with less blood loss.