Beneficial effects of sublingual misoprostol administration before elective Cesarean section under spinal anesthesia

Background Misoprostol is an inexpensive, stable, orally active prostaglandin E1 analog. Sublingualand buccal routes have been shown to reduce blood loss during Cesarean section and vasoconstrictor effects have also been observed at selected sites. Patients and methods Sixty ASA I and II female patients undergoing elective Cesarean section were included in this randomized, double-blind, controlled study. After application of standard monitors, proper fluid preload, and performance of spinal anesthesia, patients were randomly assigned to receive either two sublingual misoprostol tablets (400µg) (group A) or two white coated placebo tablets with a shape similar to that of the misoprostol tablets (group B). The intraoperatively recorded parameters included vital signs, uterine tone, blood loss, fetal APGAR score, shivering, nausea, and vomiting. The postoperativelyrecorded parameters included vital signs, shivering, nausea, vomiting, and diarrhea. Results The intraoperatively recorded parameters showed that group A patients had significantly higher mean arterial blood pressure values, significantly lower mean phenylephrine consumption (48.5 ± 7.9 vs. 125.1± 11.7 mg), lower mean oxytocin consumption (13.7 ± 1.5 vs. 22.1± 3.4 IU), and lower mean blood loss (489.7 ± 19.6 vs. 895.1± 24.8 ml); however, the APGAR scores were similar between both groups. The postoperatively recorded parameters showed significantly higher incidences of fever and shivering in group A compared with group B (23.3 vs. 6.66% and 43.3 vs. 23.3%, respectively).Conclusion Administration of sublingual misoprostol (400 µg) at the beginning of elective Cesarean section under spinal anesthesia can decrease spinal-induced hypotension and phenylephrine consumption. In addition, it decreases intraoperative blood loss and oxytocin requirement with few mild side effects and no effect on the fetus.