الفهرس 
Cesarean SectionOnly 14 pages are availabe for public view
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Abstract
Cesarean section is one of the most commonly performed obstetrical operations all over the world. Epidemiologic data report a C.S. incidence of 20% - 30% worldwide, with comparable rates in high income and low income countries. According to the most recent estimates, the average global rate of CS is 18.6%, ranging from 6.0% to 27.2% in the least and more developed regions, respectively .Countries with the highest CS rates in each region are Brazil (55.6%) and Dominican Republic (56.4%) in Latin America and the Caribbean, Egypt (51.8%) in Africa, Iran and Turkey in Asia (47.9% and 47.5%, respectively), Italy (38.1%) in Europe, United States (32.8%) in Northern America, and New Zealand (33.4%) in Oceania.
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity, especially in low- resource countries. It is responsible for around 30% of maternal deaths world wide and 12% of survivors will have severe anemia.PPH is defined as blood loss of more than 500 mL following vaginal delivery or more than 1000 mL following cesarean delivery, a loss of these amounts within 24 hours of delivery is termed early or primary PPH, whereas such losses are termed late or secondary PPH if they occur 24 hours after delivery.
Misoprostol is a prostaglandin E1 analogue with potent uterotonic action and few adverse effects at therapeutic dose. It is readily absorbed when given by oral, sublingual, buccal, vaginal or rectal route. Its easy availability, relatively low cost, thermo stability, long shelf life and ease of administration all of which appear to make it particularly suitable for use in low resource setting in developing countries.
Thus our study was held on the steps of previous studies to assess the efficiency of use of Sublingual Misoprostol to Reduce Blood loss during elective cesarean delivery: A randomised controlled trial.
In the current study a double blinded, randomized, controlled trial was carried out on 142 women attending the labor ward in Ain Shams university maternity hospital to undergo an elective cesarean section.
72 patients Received 400µg of misoprostol, sublingual at cord clamping in addition to routine uterotonics.and 70 patients Received ranitidine in addition to routine uterotonics.
The patients were monitored for the occurrence of postpartum hemorrhage in the form of intra-operative blood loss, intra-operative or post-operative need for surgical measures to stop bleeding, post-operative vaginal bleeding, also DROP in hemoglobin 24 hours postoperative.
In the current study, no significant difference between two groups as regards descriptive data,GIT upsets and need for blood transfusion of studied groups.
In the current study, Blood loss is calculated intraoperative by number of soaked towels and suction set after removal of placenta by controlled cord traction after spontaneous separation, and calculated for 1st 6 hours by number of soaked pads used after the CS, and calculated 24 hrs. Blood loss by Allowable Blood Loss (ABL) from a modification of the Gross formula.
In this current study highly significant difference in blood loss intraoperative between misoprostol (group A ) and placebo (group B ) with mean blood loss of misoprostol group (559.4±62.8) and (663.2 ±62.1) for placebo group.
Mean vaginal bleeding after 6hrs for misoprostol group was (108.3±36.6) and (150.0 ±57.7) for placebo group, this showed highly significant difference between two groups .There was also highly significant difference between two groups of blood loss after 24 hours with significant reduce of blood loss among misoprostol groups with mean of (859.7±86.1) to misoprostol group and mean of (1025.9 ±144.7) of placebo group.
In the current study no significant difference between two groups as regards Preoperative Hemoglobin. Postoperative Hemoglobin was significantly reduced in placebo group, There was significant difference between two groups in the mean decrease of HB% and HCT values with mean decrease of HB% SD (1.25±0.42) for misoprostol group and (1.46±0.70) for placebo group with mean decrease of HCT (4.91±0.70) for misoprostol group and (5.52±0.91) for placebo group.
There was significant difference of addition use of uterotonics, with P value 0.005, And also significant difference among two groups in operation time with p value 0.005.