Research Article
Sezaryen sonrası rektal olarak uygulanan misoprostolün bağırsak motilitesi ve uterus kanaması üzerine etkileri
Abstract
Amaç: Bu çalışma primipar kadınlarında elektif sezaryen sonrası uygulanan rektal misoprostolün gastrointestinal sistem motilitesi ve postpartum kanamaya etkinliğini belirlemek için tasarlanmıştır.
Gereç ve Yöntem: Bu çalışma, 2018 Nisan ve 2019 Mart tarihleri arasında tek bir kurumda sezaryen sonrası dönemde rektal misoprostol (misoprostol grubu, n = 120) veya intravenöz oksitosin (misoprostol olmayan grubu n = 120) uygulanan 240 hastada retrospektif bir kohort çalışması olarak gerçekleştirildi.
Bulgular: İlk gaz ve dışkılama süresinin ortanca değerleri misoprostol grubunda nonmisoprostol grubuna göre istatistiksel olarak anlamlı derecede daha erken idi (ilk gaz süresi sırasıyla 18 saat ve 24 saat, ilk dışkılama süresi sırasıyla 29 saat ve 36 saat idi), iki grubun postoperatif hemoglobin ve hematokrit değerleri açısından postoperatif 24. saatte ölçülen hemoglobin ve hematokrit değerlerinin (hemoglobin sırasıyla 11 g / dL ve 10,2 g / dL olduğunu, hematokritin sırasıyla % 33 ve 30,6) misoprostol grubunda nonmisoprostol grubuna göre istatistiksel olarak anlamlı derecede yüksekti. Postoperatif ateş ve titreme, misoprostolün olumsuz etkileri, misoprostol grubunda nonmisoprostol grubuna göre daha sık olarak tespit edildi.
Sonuç: Bu çalışma, CS sonrası rektal misoprostol uygulamasının, gastrointestinal sistemin motilitesini arttırarak erken gaz çıkımına ve dışkılamaya yol açtığını ve kadınlarda doğum sonu kanama miktarını azalttığını göstermiştir.
Keywords
Supporting Institution
bulunmamaktadır
Project Number
Reference number: 108400098-604.01.01-E.14127
References
- 1. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015 Jun;34(3):367-76. 2. WHO recommendations for the prevention and treatment of postpartum haemorrhage.2016 switzeland. 3. Youssef AE, Khalifa MA, Bahaa M, Abbas AM. Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial. Open Journal of Obstetrics and Gynecology. 2019 Mar 29;9(4):529-38. 4. Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev 2015; 2: CD006506. 5. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Med J 2015; 33: 227-34 6. Semiz A, Akpak YK, Yılanlıoğlu NC, Babacan A, Gönen G, Çam Gönen C, Asıliskender M, Karaküçük S. Prediction of Intraoperative Nausea and Vomiting in Caesarean Delivery Under Regional Anaesthesia. J Int Med Res 2017; DOI:10.1177/0300060516680547. 7. Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, Meurette G. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 2016 Dec;153(6):439-446. 8. Ahmed MR, Sayed Ahmed WA, Khamess RE, Youwakim MS, El-Nahas KM.Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial. J Perinat Med. 2018 Sep 25;46(7):786-790 9. American Congress of Gynecologists and Obstetricians. Obstetric hemorrhage bundle. www.acog.org/About-ACOG/ACOG-Districts/District-II/SMI-OB-Hemorrhage.(Accessed on August 30, 2017). 10. Kyaw MH, Otani K, Ching JYL, Higashimori A, Kee KM, Watanabe T, Tse YK, Lee V, Tanigawa T, Cheong PK, Suen BY, Fujiwara Y, Lam K, Arakawa T, Chan FKL. Misoprostol Heals Small Bowel Ulcers in Aspirin Users With Small Bowel Bleeding. Gastroenterology. 2018 Oct;155(4):1090-1097 11. Kobryn E, Szymusik I, Zgliczynska M, Szarla K, Kopylowska N, Piatek S, Kosinska-Kaczynska K, Wielgos M. The efficacy of misoprostol in the first trimester miscarriage treatment - an individual patients' data analysis. Neuro Endocrinol Lett. 2019 Nov 9;40(3). 12. Pimentel VM, Arabkhazaeli M, Moon J-Y, et al. Induction of labor using one dose vs multiple doses of misoprostol: a randomized controlled trial. Am J Obstet Gynecol 2018;218:614.e1-8. 13. Maged AM, Fawzi T, Shalaby MA, Samy A, Rabee MA, Ali AS, Hussein EA, Hammad B, Deeb WS. A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective cesarean delivery. Int J Gynaecol Obstet. 2019 Oct;147(1):102-107. 14. de Groot JW, Peters FT, Reyners AK. [Treatment of constipation in the palliative care phase]. Ned Tijdschr Geneeskd. 2010;154:A2224. 15. Satoh H, Amagase K, Takeuchi K. Mucosal protective agents prevent exacerbation of NSAID-induced small intestinal lesions caused by antisecretory drugs in rats. J Pharmacol Exp Ther. 2014 Feb;348(2):227-35. 16. Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI. Medical abortion in the late first trimester: a systematic review. Contraception. 2019 Feb;99(2):77-86 17. Demirci F, Somunkıran A, Gul O, Demiraran Y, Ozdemır I, Gul O.Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial. Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 410–414. 18. Shady NW, Sallam HF, Elsayed AH, Abdelkader AM, Ali SS, Alanwar A, Abbas AM. The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2019 Jun 3;32(11):1806-12. 19. Khan RU, El-Refaey H.Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003 May;101(5 Pt 1):968-74. 20. Adanikin AI, Orji EO, Fasubaa OB, Onwudiegwu U, Ijarotimi OA, Olaniyan O. The effect of post-cesarean rectal misoprostol on intestinal motility. Int J Gynaecol Obstet. 2012 Nov;119(2):159-62. 21. Lapaire O, Schneider MC, Stotz M, Surbek DV, Holzgreve W, Hoesli IM. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet. 2006 Oct;95(1):2-7. 22. Phelan JP, Ahn MO, Smith CV, Rutherford SE, Anderson E. Amniotic fluid index measurements during pregnancy. J Reprod Med. 1987 Aug;32(8):601-4. 23.Ertas IE, Ince O, Emirdar V, Gultekin E, Biler A, Kurt S. Influence of preoperative enema application onthe return of gastrointestinal function in elective Cesarean sections:a randomized controlled trial. J Matern Fetal Neonatal Med. 2019 Aug 9:1-5. 24. Sahin E, Terzioglu F. The Effect of Gum Chewing, Early Oral Hydration, and Early Mobilization on Intestinal Motility After Cesarean Birth. Worldviews Evid Based Nurs. 2015 Dec;12(6):380-8. 25. Chaudhuri P, Mandi S, Mazumdar A. Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery. J. Obstet. Gynaecol. Res. 2014 Sep;40(9):2023–2030. 26. Mervat S.-E.-A. Elsedeek Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery. International Journal of Gynecology and Obstetrics 2012 August(118) 149–152. 27. Sweed M, Mourad El-Said, Amgad Abou-Gamrah and Mohamad Ali. Comparison between 200, 400 and 600 microgram rectal misoprostol before cesarian section: A randomized clinical trial. J. Obstet. Gynaecol. Res. 2019. doi:10.1111/jog.13883. 28. Agustín Conde-Agudelo, Aníbal Nieto, Anyeli Rosas-Bermudez BA, Roberto Romero. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2013.03.015 PII: S0002-9378(13)00280-9. 29. Stobie-Hayes KM, Fewell JE. Influence of pregnancy on the febrile response to intracerebroventricular administration of PGE1 in rats. J Appl Physiol 1996;81(3):1312-5. 30. Orji EO, Olabode TO, Kuti O, Ogunniyi SO. A randomised controlled trial of early initiation of oral feeding after cesarean section. J Matern Fetal Neonatal Med 2009;22(1):65-71. 31.Lumbiganon P, Hofmeyr J, Gülmezoglu AM, Pinol A, Villar J. Misoprostol dose-related shivering and pyrexia in the third stage of labour. WHO Collaborative Trial of Misoprostol in the Management of the Third Stage of Labour. Br J Obstet Gynaecol 1999;106(4):304-8. 32. Othman ER, Fayez MF, El Aal DE, Mohamed HS, Abbas AM, Ali MK. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: a randomized clinical trial. Taiwanese Journal of Obstetrics and Gynecology. 2016 Dec 1;55(6):791-5.
Effects of rectally administered misoprostol on intestinal motility and uterine bleeding after cesarean section
Abstract
Purpose: This study was designed to determine the effectiveness of rectal misoprostol administered in primiparous women after elective cesarean to the motility of the gastrointestinal tract and postpartum hemorrhage.
Materials and Methods: This study was conducted as a retrospective cohort study of 240 patients who were administrated rectal misoprostol (misoprostol group, n=120) or intravenous oxytocin (non-misoprostol group n=120) during the postpartum period in a single institution between April 2018 and March 2019
Results: The median values of the first flatulation and defecation time were statistically significantly earlier in the misoprostol group than in the non-misoprostol group (the first flatulation time was 18 hours and 24 hours respectively, the first defecation time was 29 hours and 36 hours respectively). The comparison of the two groups in terms of postoperative hemoglobin and hematocrit values demonstrated that hemoglobin and hematocrit values measured at the postoperative 24th hour (the hemoglobin was 11 g/dL and 10,2 g/dL respectively, the hematocrit was 33% and 30.6% respectively) were statistically significantly higher in the misoprostol group than were those in the non-misoprostol group. Postoperative fever and shivering, negative effects of misoprostol, were more frequent in the misoprostol group than in the non-misoprostol group.
Conclusions: In the present study, demonstrated that the administration of rectal misoprostol after CS led to the early flatulation and defecation by increasing the motility of the gastrointestinal tract and reduced the amount of postpartum hemorrhage in the women.
Project Number
Reference number: 108400098-604.01.01-E.14127
References
- 1. Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015 Jun;34(3):367-76. 2. WHO recommendations for the prevention and treatment of postpartum haemorrhage.2016 switzeland. 3. Youssef AE, Khalifa MA, Bahaa M, Abbas AM. Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial. Open Journal of Obstetrics and Gynecology. 2019 Mar 29;9(4):529-38. 4. Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev 2015; 2: CD006506. 5. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Med J 2015; 33: 227-34 6. Semiz A, Akpak YK, Yılanlıoğlu NC, Babacan A, Gönen G, Çam Gönen C, Asıliskender M, Karaküçük S. Prediction of Intraoperative Nausea and Vomiting in Caesarean Delivery Under Regional Anaesthesia. J Int Med Res 2017; DOI:10.1177/0300060516680547. 7. Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, Meurette G. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 2016 Dec;153(6):439-446. 8. Ahmed MR, Sayed Ahmed WA, Khamess RE, Youwakim MS, El-Nahas KM.Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial. J Perinat Med. 2018 Sep 25;46(7):786-790 9. American Congress of Gynecologists and Obstetricians. Obstetric hemorrhage bundle. www.acog.org/About-ACOG/ACOG-Districts/District-II/SMI-OB-Hemorrhage.(Accessed on August 30, 2017). 10. Kyaw MH, Otani K, Ching JYL, Higashimori A, Kee KM, Watanabe T, Tse YK, Lee V, Tanigawa T, Cheong PK, Suen BY, Fujiwara Y, Lam K, Arakawa T, Chan FKL. Misoprostol Heals Small Bowel Ulcers in Aspirin Users With Small Bowel Bleeding. Gastroenterology. 2018 Oct;155(4):1090-1097 11. Kobryn E, Szymusik I, Zgliczynska M, Szarla K, Kopylowska N, Piatek S, Kosinska-Kaczynska K, Wielgos M. The efficacy of misoprostol in the first trimester miscarriage treatment - an individual patients' data analysis. Neuro Endocrinol Lett. 2019 Nov 9;40(3). 12. Pimentel VM, Arabkhazaeli M, Moon J-Y, et al. Induction of labor using one dose vs multiple doses of misoprostol: a randomized controlled trial. Am J Obstet Gynecol 2018;218:614.e1-8. 13. Maged AM, Fawzi T, Shalaby MA, Samy A, Rabee MA, Ali AS, Hussein EA, Hammad B, Deeb WS. A randomized controlled trial of the safety and efficacy of preoperative rectal misoprostol for prevention of intraoperative and postoperative blood loss at elective cesarean delivery. Int J Gynaecol Obstet. 2019 Oct;147(1):102-107. 14. de Groot JW, Peters FT, Reyners AK. [Treatment of constipation in the palliative care phase]. Ned Tijdschr Geneeskd. 2010;154:A2224. 15. Satoh H, Amagase K, Takeuchi K. Mucosal protective agents prevent exacerbation of NSAID-induced small intestinal lesions caused by antisecretory drugs in rats. J Pharmacol Exp Ther. 2014 Feb;348(2):227-35. 16. Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI. Medical abortion in the late first trimester: a systematic review. Contraception. 2019 Feb;99(2):77-86 17. Demirci F, Somunkıran A, Gul O, Demiraran Y, Ozdemır I, Gul O.Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial. Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 410–414. 18. Shady NW, Sallam HF, Elsayed AH, Abdelkader AM, Ali SS, Alanwar A, Abbas AM. The effect of prophylactic oral tranexamic acid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2019 Jun 3;32(11):1806-12. 19. Khan RU, El-Refaey H.Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003 May;101(5 Pt 1):968-74. 20. Adanikin AI, Orji EO, Fasubaa OB, Onwudiegwu U, Ijarotimi OA, Olaniyan O. The effect of post-cesarean rectal misoprostol on intestinal motility. Int J Gynaecol Obstet. 2012 Nov;119(2):159-62. 21. Lapaire O, Schneider MC, Stotz M, Surbek DV, Holzgreve W, Hoesli IM. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet. 2006 Oct;95(1):2-7. 22. Phelan JP, Ahn MO, Smith CV, Rutherford SE, Anderson E. Amniotic fluid index measurements during pregnancy. J Reprod Med. 1987 Aug;32(8):601-4. 23.Ertas IE, Ince O, Emirdar V, Gultekin E, Biler A, Kurt S. Influence of preoperative enema application onthe return of gastrointestinal function in elective Cesarean sections:a randomized controlled trial. J Matern Fetal Neonatal Med. 2019 Aug 9:1-5. 24. Sahin E, Terzioglu F. The Effect of Gum Chewing, Early Oral Hydration, and Early Mobilization on Intestinal Motility After Cesarean Birth. Worldviews Evid Based Nurs. 2015 Dec;12(6):380-8. 25. Chaudhuri P, Mandi S, Mazumdar A. Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery. J. Obstet. Gynaecol. Res. 2014 Sep;40(9):2023–2030. 26. Mervat S.-E.-A. Elsedeek Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery. International Journal of Gynecology and Obstetrics 2012 August(118) 149–152. 27. Sweed M, Mourad El-Said, Amgad Abou-Gamrah and Mohamad Ali. Comparison between 200, 400 and 600 microgram rectal misoprostol before cesarian section: A randomized clinical trial. J. Obstet. Gynaecol. Res. 2019. doi:10.1111/jog.13883. 28. Agustín Conde-Agudelo, Aníbal Nieto, Anyeli Rosas-Bermudez BA, Roberto Romero. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2013.03.015 PII: S0002-9378(13)00280-9. 29. Stobie-Hayes KM, Fewell JE. Influence of pregnancy on the febrile response to intracerebroventricular administration of PGE1 in rats. J Appl Physiol 1996;81(3):1312-5. 30. Orji EO, Olabode TO, Kuti O, Ogunniyi SO. A randomised controlled trial of early initiation of oral feeding after cesarean section. J Matern Fetal Neonatal Med 2009;22(1):65-71. 31.Lumbiganon P, Hofmeyr J, Gülmezoglu AM, Pinol A, Villar J. Misoprostol dose-related shivering and pyrexia in the third stage of labour. WHO Collaborative Trial of Misoprostol in the Management of the Third Stage of Labour. Br J Obstet Gynaecol 1999;106(4):304-8. 32. Othman ER, Fayez MF, El Aal DE, Mohamed HS, Abbas AM, Ali MK. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: a randomized clinical trial. Taiwanese Journal of Obstetrics and Gynecology. 2016 Dec 1;55(6):791-5.
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Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Project Number | Reference number: 108400098-604.01.01-E.14127 |
| Publication Date | September 30, 2020 |
| Acceptance Date | June 20, 2020 |
| Published in Issue | Year 2020 Volume: 45 Issue: 3 |
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