Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum tim...Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.展开更多
<strong>Background</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>: </strong>With newer protocols, s...<strong>Background</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>: </strong>With newer protocols, such as delayed cord clamping, becoming routine practice, determining the potential maternal consequences is important. In particular, establishing normative values for blood loss from the hysterotomy would be helpful in addressing techniques to minimize total blood loss for cesarean deliveries. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: Blood loss from the hysterotomy during cesarean delivery has not been reported using quantitative methods. We aimed to quantify the rate of blood loss during cesarean delivery from the hysterotomy between creation and closure. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This single center, prospective, case series was collected in 2018. Women with singleton pregnancies undergoing cesarean delivery at </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≥</span><span><span style="font-family:Verdana;">37 0/7 weeks at Brigham and Women’s Hospital were included. Delayed cord clamping was performed which allowed for quantification of blood loss through gravimetric methods and descriptive statistics were performed. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: Twenty patients were included. The mean hysterotomy closure delay for cord blood collection was 47 seconds (SD 10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL). Blood loss per minute was calculated with a median of 150 </span><span style="font-family:Verdana;">mL/minute (IQR 88.8 mL, 95% CI 109.2 - 190.4 mL). The mean post-operative </span><span style="font-family:Verdana;">hematocrit drop was 4.4%, and there were no blood transfusions. There was a single hysterotomy extension and a quantified blood loss of 413 mL per minute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: We found a mean blood loss of 150 mL/min without hysterotomy extension. With a hysterotomy extension, the blood lost per minute was more profound. This normative data can be helpful for surgical planning with regards to delayed cord clamping or cord blood collection for banking.</span></span></span></span></span>展开更多
文摘Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.
文摘<strong>Background</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>: </strong>With newer protocols, such as delayed cord clamping, becoming routine practice, determining the potential maternal consequences is important. In particular, establishing normative values for blood loss from the hysterotomy would be helpful in addressing techniques to minimize total blood loss for cesarean deliveries. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: Blood loss from the hysterotomy during cesarean delivery has not been reported using quantitative methods. We aimed to quantify the rate of blood loss during cesarean delivery from the hysterotomy between creation and closure. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This single center, prospective, case series was collected in 2018. Women with singleton pregnancies undergoing cesarean delivery at </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">≥</span><span><span style="font-family:Verdana;">37 0/7 weeks at Brigham and Women’s Hospital were included. Delayed cord clamping was performed which allowed for quantification of blood loss through gravimetric methods and descriptive statistics were performed. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: Twenty patients were included. The mean hysterotomy closure delay for cord blood collection was 47 seconds (SD 10.2) and the mean maternal blood volume collected was 110.8 mL (SD 53.4 mL). Blood loss per minute was calculated with a median of 150 </span><span style="font-family:Verdana;">mL/minute (IQR 88.8 mL, 95% CI 109.2 - 190.4 mL). The mean post-operative </span><span style="font-family:Verdana;">hematocrit drop was 4.4%, and there were no blood transfusions. There was a single hysterotomy extension and a quantified blood loss of 413 mL per minute. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: We found a mean blood loss of 150 mL/min without hysterotomy extension. With a hysterotomy extension, the blood lost per minute was more profound. This normative data can be helpful for surgical planning with regards to delayed cord clamping or cord blood collection for banking.</span></span></span></span></span>
