A Comparative Study Between Rectal and Intrauterine Misoprostol Administration in the Reduction of Blood Loss During and After Elective Cesarean Delivery in Low Risk Women

Intrauterine Misoprostol Group (n=70) Participants received 400 μg of misoprostol (Cytotec, Pfizer, G.D. Searle LLC) administered intrauterinely after placental delivery during cesarean section. The dose was divided as 200 μg placed at each uterine cornu.

Rectal Misoprostol Group (n=70) Participants received 400 μg of misoprostol (Cytotec, Pfizer, G.D. Searle LLC) administered rectally via urinary catheter insertion preoperatively Standard Care All participants received standard active management of the third stage of labor including: Intravenous bolus of 5 IU oxytocin after fetal delivery 20 IU oxytocin diluted in 500 mL lactated Ringer's solution infused at 125 mL/hour Surgical Protocol All cesarean deliveries were performed under spinal anesthesia using a standardized surgical technique

Inclusion criteria

• Low risk women with singleton living fetus scheduled for elective cesarean delivery
• American Society of Anesthesiologists (ASA) physical status I or II
• Age: 20-40 years
• Parity: 0-3
• Gestational age: 37-40 completed weeks
• Body mass index (BMI): 18-30 kg/m²
• Planned spinal anesthesia
• Provision of informed consent

Exclusion criteria

• High risk pregnancies (anemia, renal disease, cardiac disease, hepatic disease, coagulopathies)
• Increased risk for obstetric hemorrhage (placenta previa, placenta accreta spectrum, polyhydramnios, history of PPH, uterine rupture, uterine fibroids)
• Allergy to prostaglandins or prostaglandin contraindications (e.g., asthma)
• Complicated cesarean sections (bladder/ureteric injury, intestinal injury, massive intraoperative bleeding)
• Known fetal or structural anomalies
• Refusal to participate