Efficacy of Prophylactic Sublingual Misoprostol combined with Oxytocin versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Cesarean Birth for Multiple Pregnancies

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 831–842

DOI: 10.46882/2026/IJOG/000550

Original Research Article

Title: Efficacy of Prophylactic Sublingual Misoprostol combined with Oxytocin versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Cesarean Birth for Multiple Pregnancies

Names of Authors: Oluwaseun A. Adebayo¹, Aminat Z. Yusuf¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Multiple gestations induce profound uterine overdistension, predisposing women to severe uterine atony and postpartum hemorrhage (PPH) during cesarean deliveries. This double-blind randomized controlled trial compared the prophylactic efficacy and safety of a combination of sublingual misoprostol plus low-dose oxytocin against standard high-dose oxytocin infusion alone in multiple pregnancies. Two hundred pregnant women with twin or triplet gestations undergoing scheduled cesarean delivery under spinal anesthesia were randomized into two arms (n = 100 per group). The misoprostol group received 400 μg sublingual misoprostol immediately following skin incision plus a 5 IU intravenous oxytocin bolus after fetal extraction. The control group received a matching sublingual placebo and a standard 20 IU intravenous oxytocin infusion administered over 4 hours. The primary outcome was total perioperative blood loss. The mean perioperative blood loss was significantly lower in the misoprostol-oxytocin group compared to the control group (642.5 ± 150.4 mL vs. 885.6 ± 210.2 mL, p < 0.001). The primary PPH rate (blood loss ≥ 1,000 mL) was also lower in the combination cohort (4.0% vs. 14.0%, p = 0.021). Postpartum hemoglobin drops were significantly smaller in the misoprostol arm (0.82 ± 0.24 g/dL vs. 1.42 ± 0.38 g/dL, p < 0.001). Transient shivering (32.0% vs. 6.0%, p < 0.001) and low-grade pyrexia were more common in the misoprostol group. Prophylactic sublingual misoprostol combined with low-dose oxytocin provides superior hemostatic efficacy and minimizes perioperative blood loss during multiple-gestation cesarean births compared to standard oxytocin infusion alone.

Keywords: Multiple Pregnancy; Cesarean Section; Misoprostol; Oxytocin; Postpartum Hemorrhage; Uterine Atony.

Manuscript Timeline: Received: July 22, 2026; Revised: August 25, 2026; Accepted: September 05, 2026; Published: September 10, 2026.

Citation: Adebayo OA, Yusuf AZ. Efficacy of Prophylactic Sublingual Misoprostol combined with Oxytocin versus Oxytocin Alone for Postpartum Hemorrhage Prevention during Cesarean Birth for Multiple Pregnancies. International Journal of Obstetrics and Gynecology. 2026; 14(9): 831–842.

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