Sezaryen sonrası rektal olarak uygulanan misoprostolün bağırsak motilitesi ve uterus kanaması üzerine etkileri

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.

Effects of rectally administered misoprostol on intestinal motility and uterine bleeding after cesarean section

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 2019Results: 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.

Keywords:

rectal misoprostol, uterine bleeding ceseran section,

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1. Bragg D, El-Sharkawy AM, Psaltis E, MaxwellArmstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015;34:367-76.
2. WHO. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, WHO, 2016.
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;9:529-38.
4. Short V, Herbert G, Perry R, Atkinson C, Ness AR, Penfold C, 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 et al. Prediction of intraoperative nausea and vomiting in caesarean delivery under regional anaesthesia. J Int Med Res. 2017;45:332-9.
7. Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A et al. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg. 2016;153:439- 46.
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;46:786-790.
9. American Congress of Gynecologists and Obstetricians (ACOG). Obstetric hemorrhage bundle. www.acog.org/About-ACOG/ACOGDistricts/District-II/SMI-OBHemorrhage.(Accessed on August 30, 2017).
10. Kyaw MH, Otani K, Ching JYL, Higashimori A, Kee KM, Watanabe T et. al. misoprostol heals small bowel ulcers in aspirin users with small bowel bleeding. Gastroenterology. 2018;155:1090-7.
11. Kobryn E, Szymusik I, Zgliczynska M, Szarla K, Kopylowska N, Piatek S et al. The efficacy of misoprostol in the first trimester miscarriage treatment - an individual patients' data analysis. Neuro Endocrinol Lett. 2019;40:152–8.
12. Pimentel VM, Arabkhazaeli M, Moon J-Y, et al. Induction of labor using one dose vs multipledoses of misoprostol: a randomized controlled trial. Am J Obstet Gynecol. 2018;218:614-8.
13. Maged AM, Fawzi T, Shalaby MA, Samy A, Rabee MA, Ali AS et. al. 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;147:102-107.
14. de Groot JW, Peters FT, Reyners AK. Treatment of constipation in the palliative care phase. Ned Tijdschr Geneeskd. 2010;154:22-24.
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;348:227-35.
16. Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI. Medical abortion in the late first trimester: a systematic review. Contraception. 2019;99:77-86.
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. Aust N Z J Obstet Gynaecol. 2007;47:410–4.
18. Shady NW, Sallam HF, Elsayed AH, Abdelkader AM, Ali SS, Alanwar A et al. The effect of prophylactic oral tranexamicacid plus buccal misoprostol on blood loss after vaginal delivery: a randomized controlled trial. J Matern Fetal Neonatal Med.. 2019;32:1806-12.
19. Khan RU, El-RefaeyH. Pharmaco kinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003;101:968-74.
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;119:159-62.
21. Phelan JP, Ahn MO, Smith CV, Rutherford SE, Anderson E. Amniotic fluid index measurements during pregnancy. J Reprod Med. 1987;32:601-4.
22. 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;95:2-7.
23. Ertas IE, Ince O, Emirdar V, Gultekin E, Biler A, Kurt S. Influence of preoperative enema application on the return of gastrointestinal function in elective Cesarean sections: a randomized controlled trial. J Matern Fetal Neonatal Med. 2019;9:1-5.
24. Chaudhuri P, Mandi S, Mazumdar A. Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing postpartum hemorrhage after cesarean delivery. J Obstet Gynaecol Res. 2014;40:2023–2030.
25. Elsedeek MS. Impact of preoperative rectal misoprostol on blood loss during and after elective cesarean delivery. Int J Gynaecol Obstet. 2012;118:149-52.
26. Sweed M, Mourad El-Said, Abou-Gamrah A, Ali M. Comparison between 200, 400 and 600 microgram rectal misoprostol before cesarian section: A randomized clinical trial. J Obstet Gynaecol Res. 2019;45:585-91.
27. Conde-Agudelo A, Nieto A, Rosas-Bermudez A, Romero R. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. Am J Obstet Gynecol. 2013;209:40.e1-17.
28. Stobie-Hayes KM, Fewell JE. Influence of pregnancy on the febrile response to intracerebroventricular administration of PGE1 in rats. J Appl Physiol. 1996;81:1312-5.
29. Orji EO, Olabode TO, Kuti O, Ogunniyi SO. A randomised controlled trial of early initiation of oral feding after cesarean section. J Matern Fetal Neonatal Med. 2009;22:65-71.
30. 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;106:304-8.