Effect of Melatonin on Blood Loss After Cesarean Section: A Prospective Randomized Double-Blind Trial

Impact of Melatonin as a Premedication Agent in Caesarean Section on Blood Loss and Postoperative Pain Level

Background

Postpartum hemorrhage (PPH) is a serious postdelivery condition with a high incidence of morbidity and mortality for women who undergo childbirth with or without a caesarean section. Melatonin has been suggested to increase the contractility of myometrium and reduce the pain score postoperatively, therefore it is believed that the use of melatonin before surgery may decrease blood loss, reduce pain score, and decrease the need for postoperative opioids.

Objectives

The main objectives of this study are focused on the investigation of melatonin as a premedication agent to reduce blood loss and decrease pain score postoperatively in patients undergoing cesarean section under spinal anesthesia.

Methods

80 patients were scheduled for spinal anesthesia-based cesarean sections and randomly assigned to two groups, melatonin group (M) 40 patients and placebo group (P) 40 patients to receive either 10 mg of sublingual melatonin or a placebo of 90 minutes preoperatively. Hemoglobin levels were been measured preoperative and 12 hrs. Postoperatively, blood loss volume was calculated by measuring both the weight of used materials before and after the surgery and the volume sucked in the suction bottle after placental delivery. Postoperative visual pain score and analgesic requirements were used to evaluate pain levels.

Results

Analyzed collected data showed a significant decrease in blood loss in the melatonin group in comparison with the placebo group as measured by the hemoglobin level. On the other hand, there is a significant decrease in pain score and analgesia requirement with the melatonin group compared to the placebo group.

Conclusion

Melatonin is a promising premedication drug that has a significant impact on postpartum hemorrhage by reducing blood loss and pain levels of mothers who have undergone C-sections.

Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in pregnant women who were scheduled for elective CS. Methods: We systemically searched 4 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception until 10 March 2023. We included randomized controlled trials (RCTs) comparing melatonin and placebo for postoperative outcomes in CS patients. For risk of bias assessment, we used the Cochrane Risk of Bias 2 tool. Continuous variables were pooled as mean difference (MD), and categorical variables were pooled as a risk ratio (RR) with a 95% confidence interval (CI). Results: We included 7 studies with a total of 754 pregnant women scheduled for CS. The melatonin group had a lower pain score (MD = -1.23, 95% CI [-1.94, -0.51], p < 0.001) and longer time to first analgesic request (MD = 60.41 min, 95% CI [45.47, 75.36], p < 0.001) than the placebo group. No difference was found regarding hemoglobin levels, heart rate, mean arterial pressure, total blood loss, or adverse events. Conclusions: Preoperative melatonin may reduce postoperative pain in CS patients without side effects. This research offers a safe and affordable pain management method for this population, which has clinical consequences. Further research is needed to validate these findings and determine the best melatonin dosage and timing.

Innovations in the prevention and treatment of postpartum hemorrhage: Analysis of a novel medicines development pipeline database

Background

A significant barrier to improving prevention and treatment of postpartum hemorrhage (PPH) is a lack of innovative medicines that meet the needs of women and providers, particularly those in low‐and middle‐income countries (LMICs). The Accelerating Innovation for Mothers (AIM) project established a new database of candidate medicines under development for five pregnancy‐related conditions between 2000 and 2021.

Objective

To systematically identify and rank candidates for prevention and treatment of PPH.

Search Strategy

Adis Insight, Pharmaprojects, WHO ICTRP, PubMed, and grant databases were searched to develop the AIM database.

Selection Criteria

AIM database was searched for candidates being evaluated for PPH prevention and treatment, regardless of phase.

Data Collection and Analysis

Candidates were ranked as high, medium, or low potential based on prespecified criteria. Analysis was primarily descriptive, describing candidates and development potential.

Main Results

Of the 444 unique candidates, only 39 pertained to PPH. One was high potential (heat‐stable/inhaled oxytocin) and three were medium potential (melatonin, vasopressin and dofetilide via nanoparticle delivery).

Conclusion

The pipeline for new PPH medicines is concerningly limited, lacking diversity, and showing little evidence of novel technologies. Without significant investment in early‐phase research, it is unlikely that new products will emerge.

A new database of maternal medicine development shows few new PPH candidates are in the pipeline. Significant investment is needed, particularly in early‐phase research.

Abstract No.: ABS2482: A comparative study to evaluate the effect of melatonin on blood loss after elective Caesarean section: a randomised double blind study

Background & Aims:

Postpartum hemorrhage (PPH) being a cause for one-third of obstetric deaths, its prevention helps decreasing blood loss at caesarean section. Melatonin acts on MT1 and MT2 receptors in the myometrium, and similarities between melatonin and oxytocin signaling could lead to increased contractility.

Methods:

After obtaining informed-written-consent, patients were randomly allocated to 2 groups, of 30 each to receive either melatonin 3mg (group M3), or placebo (group P) orally, 1h before spinal-anaesthesia. Patient was preloaded with 10ml/kg ringer-lactate solution. In operating-room, standard monitoring was connected. Oxygen was delivered at 4L/min. SAB was administered, and motor-blockade determined using modified-Bromage-scale. After delivery, injection oxytocin was given. Haemoglobin values were determined before and 12h after surgery. Blood-loss (ml) was measured-as a) the difference between the weight of used materials before and after the surgery and b) the volume of suction after placental delivery. The sedation score assessment was done. Neonatal Apgar score and birth weight were noted.

Results:

There was significant difference between group M and group P in total blood loss with mean 1357.17 and 1440 and standard deviation 162.82 and 170.31 respectively with p=0.029539.

Conclusion:

The use of melatonin 3mg orally as premedication in pregnant patients undergoing cesarean section under spinal anaesthesia could statistically decrease the amount of blood loss after caesarean section.

Melatonin for the Management of Preeclampsia: A Review

Preeclampsia is a disease specific to pregnancy characterised by new-onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For sixty years, antihypertensives have been the mainstay of treating preeclampsia and only recently have insights into the pathogenesis of the disease opened new avenues for novel therapies. Melatonin is one such option, an endogenous and safe antioxidant, that may improve the maternal condition in preeclampsia while protecting the fetus from a hostile intrauterine environment. Here we review the evidence for melatonin as a possible adjuvant therapy for preeclampsia, including in vitro evidence supporting a role for melatonin in protecting the human placenta, preclinical models, vascular studies, and clinical studies in hypertension and pregnancy.