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

One hundred forty low risk pregnant women scheduled for elective cesarean delivery were randomized (1:1) into two groups: the intrauterine group (n=70) received 400 μg misoprostol (200 μg at each uterine cornu) after placental delivery, while the rectal group (n=70) received 400 μg misoprostol rectally via urinary catheter insertion preoperatively.

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