Postpartum HemorrhagePhase 3NCT06765473
Comparison Between Preoperative Vaginal and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage During Cesarean Section
A Phase 3 study testing Misoprostol in people with Postpartum Hemorrhage, run by Assiut University.
Trial summary
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Postpartum Hemorrhage
- What is being tested?
- Misoprostol
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 400 participants
- Where
- No sites listed yet
- Study dates
- 1 Jan 2025to 1 Mar 2026
- Phase
- Phase 3
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- The study includes women will undergo elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing
Who cannot join
- Women with placenta previa . preterm delivery, hypertensive disorders of pregnancy, bleeding tendency, previous history of PPH, concurrent anticoagulant therapy, concurrent long-term use of steroids, fetal distress and antepartum haemorrhage will be excluded from the study
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during CS. In 2011, a systematic review that included twenty-one studies revealed that there is an increased incidence of intraoperative blood loss and blood transfusion with an increased number of cesarean deliveries [19]. Previous reports have shown that misoprostol is effective in reducing blood loss during and after cesarean delivery regardless of route of administration [20] . However, the optimum time for administration of misoprostol to decrease the amount of PPH is still under discussion. A. E. A. Youssef et al. DOI: 10.4236/ojog.2019.94052 531 Open Journal of Obstetrics and Gynecology Therefore the current study aims to compare the effect of preoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) in reducing the amount of blood loss during and 24 hours after CS.
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during
Read the detailed description
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during CS. In 2011, a systematic review that included twenty-one studies revealed that there is an increased incidence of intraoperative blood loss and blood transfusion with an increased number of cesarean deliveries [19]. Previous reports have shown that misoprostol is effective in reducing blood loss during and after cesarean delivery regardless of route of administration [20] . However, the optimum time for administration of misoprostol to decrease the amount of PPH is still under discussion. A. E. A. Youssef et al. DOI: 10.4236/ojog.2019.94052 531 Open Journal of Obstetrics and Gynecology Therefore the current study aims to compare the effect of preoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) in reducing the amount of blood loss during and 24 hours after CS.
- Conditions
- Postpartum Hemorrhage
- Being tested
- Misoprostol
- Medical subject headings
- Postpartum Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
MisoprostolDrug
preoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) to reducing the amount of blood loss during and 24 hours after CS to determine the optimum time for drug administration.
| Study group | Role | What they receive |
|---|---|---|
| CS group | Active comparator | women who will undergo elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing Receives: Drug: Misoprostol |
What is being measured
The primary outcome is the main question the study is designed to answer.
the amount of blood loss
the amount of blood loss during and 24 hours after CS
Measured: 24 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Jan 2025
- Study start1 Jan 2025 (estimated)
- Primary completion1 Jan 2026 (estimated)
- Study completion1 Mar 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Postpartum HemorrhageStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 400 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ahmed Mohamed Hatem Fouad, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06765473
- Sponsor's protocol ID
- Pre-vaginal+ Postperative PPH
- Status last verified
- Jan 2025
- First submitted
- 27 Dec 2024
- Last updated
- 9 Jan 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Acharya G, Al-Sammarai MT, Patel N, Al-Habib A, Kiserud T. A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section. Acta Obstet Gynecol Scand. 2001 Mar;80(3):245-50. doi: 10.1034/j.1600-0412.2001.080003245.x.
PubMed 11207490
Study at a glance
From the registry record, last updated by the sponsor on 9 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison Between Preoperative Vaginal and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage During Cesarean Section
- ClinicalTrials.gov ID
- NCT06765473
- Acronym / sponsor ID
- Pre-vaginal+ Postperative PPH
- Conditions
- Postpartum Hemorrhage
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 400 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Jan 2025 (estimated)
- Primary completion
- 1 Jan 2026 (estimated)
- Study completion
- 1 Mar 2026 (estimated)
- First posted
- 9 Jan 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during CS. In 2011, a systematic review that included twenty-one studies revealed that there is an increased incidence of intraoperative blood loss and blood transfusion with an increased number of cesarean deliveries [19]. Previous reports have shown that misoprostol is effective in reducing blood loss during and after cesarean delivery regardless of route of administration [20] . However, the optimum time for administration of misoprostol to decrease the amount of PPH is still under discussion. A. E. A. Youssef et al. DOI: 10.4236/ojog.2019.94052 531 Open Journal of Obstetrics and Gynecology Therefore the current study aims to compare the effect of preoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) in reducing the amount of blood loss during and 24 hours after CS.
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during
Detailed description
Cesarean section (CS) is one of the most frequently performed operative interventions worldwide [1]. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications [2] including primary postpartum hemorrhage (PPH). Primary PPH is defined as a blood loss of more than 1000 ml during the first 24 hours after delivery [3], and it is the most common cause of maternal mortality worldwide [4]. Misoprostol is a synthetic prostaglandin E1 analog, commonly used for the prevention and management of PPH. It has potent uterotonic properties and fewer side effects at therapeutic doses [5]; it is absorbed orally, vaginally and across the mucous membranes of the rectum and oral cavity [6] [7] [8]. Misoprostol is affordable, widely available, and easily administrated via multiple routes, and has a good safety profile if properly administrated and monitored, all of which might make it the standard treatment option for PPH in low-resource settings [9]. The benefits (cervical dilatation and uterine contractions) and the adverse effects (nausea, vomiting, diarrhea, fever, and chills) are dose-dependent [10]. Hofmeyr et al. studied the pharmacokinetics of misoprostol administered by various routes. According to this study, the oral route has the most rapid uptake, but the shortest duration. The rectal route has slow uptake but prolonged duration. The buccal and sublingual routes have rapid uptake, prolonged duration and greatest total bioavailability [11]. Besides that, it can be used for termination of pregnancy in cases of missed or incomplete miscarriage [12] [13]. Also, in cases with retained placenta, it may have a role in the management of associated bleeding which mostly results from atony [14] [15]. In the field of gynecology, misoprostol could be used for induction of cervical ripening before office gynecological procedures [16] [17] [18]. This could decrease the associated pain induced by transcervical passage of instruments. Intraoperative blood loss is one of the important complications during CS. In 2011, a systematic review that included twenty-one studies revealed that there is an increased incidence of intraoperative blood loss and blood transfusion with an increased number of cesarean deliveries [19]. Previous reports have shown that misoprostol is effective in reducing blood loss during and after cesarean delivery regardless of route of administration [20] . However, the optimum time for administration of misoprostol to decrease the amount of PPH is still under discussion. A. E. A. Youssef et al. DOI: 10.4236/ojog.2019.94052 531 Open Journal of Obstetrics and Gynecology Therefore the current study aims to compare the effect of preoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) in reducing the amount of blood loss during and 24 hours after CS.
Study design
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| CS group | Active comparator | Drug: Misoprostolwomen who will undergo elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- The study includes women will undergo elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing
Key exclusion criteria (1 listed)
- Women with placenta previa . preterm delivery, hypertensive disorders of pregnancy, bleeding tendency, previous history of PPH, concurrent anticoagulant therapy, concurrent long-term use of steroids, fetal distress and antepartum haemorrhage will be excluded from the study
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Misoprostolpreoperative vaginal and postoperative sublingual administration of misoprostol (800 μg) to reducing the amount of blood loss during and 24 hours after CS to determine the optimum time for drug administration. | Drug | CS group |
Primary outcome
the amount of blood loss
Time frame: 24 hours
the amount of blood loss during and 24 hours after CS
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Jan 2025.
- Results publication: PubMed 11207490Acharya G, Al-Sammarai MT, Patel N, Al-Habib A, Kiserud T. A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra-operative blood loss during cesarean section. Acta Obstet Gynecol Scand. 2001 Mar;80(3):245-50. doi: 10.1034/j.1600-0412.2001.080003245.x.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Misoprostol in people with Postpartum Hemorrhage, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 9 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Ahmed Mohamed Hatem Fouad, resident doctor (+201025178300, ahmeddhatemm22@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
the amount of blood loss (time frame: 24 hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06765473, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2025.