الفهرس 
POST--PARTUM HEMORRHAGE PPH))Only 14 pages are availabe for public view
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Abstract
Postpartum hemorrhage continues to be the leading cause of maternal morbidity and mortality worldwide and that is according to estimate of the World Health Organization in 2008. Average blood loss during delivery progressively increases with mode of delivery; vaginal delivery (500ml), cesarean section (1000ml), emergency hysterectomy (3500ml) of blood.
Excessive blood loss as estimated by a 10% DROP in hematocrit post delivery or by need for blood transfusion occurs in approximately 4% of vaginal deliveries and 6% of cesarean births.
A reduction of operative blood loss at cesarean section is beneficial to the patients in terms of decreased post operative morbidity and a decrease in risks associated with blood transfusion. The routine use of oxytocin is associated with a significant reduction in the occurrence of post partum hemorrhage.
Misoprostol is an easy alternative to be used for the prevention of post partum hemorrhage being used via multiple routes and is heat stable and also inexpensive; hence comes its importance in preventing post partum hemorrhage.
The aim of this work is to assess the effecacy and safety of preoperative rectal misoprostol of a dose of 800 mcg in preventin uterine atony and blood loss compared with intra-operative dose of oxytocin (20 I.U) infusion, on reduction of intra and post operative blood loss in cesarean section and prevention of post partum hemorrhage.
In order to achieve this objective 150 women undergoing elective cesarean section were participated in the study, half of them (75) were given (800mcg) misoprostol rectally preoperatively just before induction of anesthesia and the other (75) were given only (20 I.U) oxytocin by intravenous infusion after delivery of the baby.
All women participated in the study were examined before joining to find any of the exclusion criteria, and they also had their pulse, blood pressure and temperature measured with general examination and history was taken from them all.
The primary outcomes were the difference between the 2 groups in the estimated blood loss and change in hemoglobin and hematocrit values while the secondary outcomes were taken in consideration and compared between the 2 groups of patients which are the postoperative blood loss,postoperative hemoglobin concentreation, postoperative adverse effects (abdominal pain, nausea, vomiting, diarrea, pyrexia, hot flushes and tiredness), apgar score at 1 and 5 minutes.
The results showed that preoperative rectal administration of 800 mcg misoprostol at time of induction of anaethesia in patients who are free of risks of post partum hemorrhage and undergoing elective cesarean section had an insignificant effect in decreasing the intraoperative blood loss and prevention of post partum hemorrhage as rectal misoprostol was insignificantly associated with intraoperative EBL, it was insignificantly associated with postpartum hemoglobin DROP, and finally it was insignificantly associated with need for blood transfusion, and insignificantly associated with changes in Apgar scores.