Archives of Gynecology and Obstetrics

, Volume 298, Issue 6, pp 1115–1122 | Cite as

Rectal vs. sublingual misoprostol before cesarean section: double-blind, three-arm, randomized clinical trial

  • Mohamed S. SweedEmail author
  • Mourad M. El-Saied
  • Amgad E. Abou-Gamrah
  • Haitham A. El-Sabaa
  • Mohamed M. Abdel-Hamid
  • Hossam Hemeda
  • Ahmed M. Mansour
  • Mohamed E. Shawky
  • Medhat A. El-Sayed
  • Radwa M. Mohamed
Maternal-Fetal Medicine



The commonest surgical procedure for women is cesarean delivery. Postpartum hemorrhage and intra-operative blood during cesarean delivery is a major concern to all obstetricians. This study was conducted to assess the efficacy of the adjuvant use of misoprostol and oxytocin in decreasing intra-operative blood loss in cesarean delivery.


This was a double-blinded randomized clinical trial including 636 term pregnant woman scheduled for cesarean section at Ain Shams University Maternity Hospital, Cairo, Egypt, between February 2013 and February 2014. Participants received either 400-μg misoprostol rectally or sublingually or placebo before cesarean section together with 5-IU oxytocin IV. The main outcome measure was intra-operative blood loss. Difference between the three groups was analyzed using one-way ANOVA test (for numeric variables) and Chi-square test (for categorical variables). P < 0.05 was considered statistically significant.


Intra-operative blood loss was higher in patients who did not receive misoprostol (Placebo Group) (295–1075 ml, 641.7 ± 135.7) than those who received it, regardless the route of administration, rectal (135–830 ml, 457.5 ± 140.7; P < 0.001), and sublingual (135–680 ml, 357.8 ± 129.7; P < 0.001). In addition, sublingual route was associated with significantly lower estimated intra-operative blood loss compared to rectal administration (P < 0.001).


Misoprostol with oxytocin is an effective drug-combination for decreasing intra-operative blood loss during cesarian section with clinical superiority to sublingual over rectal route.


Cesarean section Misoprostol Oxytocin Postpartum hemorrhage Rectal administration Sublingual administration 



This work was supported by Ain-Shams University.

Author contributions

MS: protocol/project development, data analysis, and manuscript writing/editing. ME-S: protocol/project development. AA-G: protocol/project development. HE-S: data collection or management. MA-H: data collection or management. HH: data collection or management. AMM: data collection or management. MES: data collection or management. MAE-S: data collection or management. RMM: data collection or management.


This study did not receive any funds from any organization.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was obtained from the ethical committee of the Department of Obstetrics and Gynecology, Ain-Shams University (Approval Number: 3458).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mohamed S. Sweed
    • 1
    Email author
  • Mourad M. El-Saied
    • 1
  • Amgad E. Abou-Gamrah
    • 1
  • Haitham A. El-Sabaa
    • 1
  • Mohamed M. Abdel-Hamid
    • 1
  • Hossam Hemeda
    • 1
  • Ahmed M. Mansour
    • 1
  • Mohamed E. Shawky
    • 1
  • Medhat A. El-Sayed
    • 1
  • Radwa M. Mohamed
    • 1
  1. 1.Obstetrics and Gynecology DepartmentAin Shams UniversityCairoEgypt

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