الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
 |  | from | 103 |  |  |
| | | from | 103 | | |
Abstract
All over the world ,postpartum hemorrhage is considered the leading cause of maternal morbidity and mortality with prevelance rate of 6% to 10%. Mortality from PPH in developing countries has remained high despite the interventiona l efforts to decrease maternal moretality since the launch of the safe of motherhood in 1987 . although the available data are quite limited , studies have shown PPH to account for 25%of maternal deaths in Egypt .
The most dangerous cause of PPH is uterine atony which is observed alone in 50% to 60% of cases . Active mangement compare to expectant of third stage of labour lowers maternal blood loss and reduce the risk of PPH by aboute 60%.several randamized trials provide evidance that the administration oxytocin alone or in combination with ergometrine reduce the incidance of PPH by around 40%
Carbetocin is a synthetic analoge of oxytocin with a half – life 4to 10 times longer than that of oxytocin . it is used as a single- dose injection instead of an infusion and can be given IV or IM . preliminary studies , also of small sizee ,showed that it is well tolerated and can be a promising drug.
The present study was designed to compare the efficacy and safety of carbetociin versus, WHO protocol (oxytocin 20 IU ) ,versus misoprotol in prevention of PPH in low risk cases during elective CS. About 90 patients were enrolled in this study from the ante natal care clinic of the department of obstetrics &Gynecology ,of EL –Minya University Hospital and Matay general hospital , with gestational age between 37-42 weeks of pregnancy , having no risk factor for PPH . they were allocated into 3 groups equal in number .group A received 20 IU of of oxytocin adminstered through IV route as early as possible after delivery of anterior shoulder ,groupB received 100microgram carbetocin also IV early early after delivery of anterior shoulder of baby and group C received 800mg of misoprostol administered rectal just after induction of anesthesia :
In the present study the participants of three groups were smilar as regards maternal age , parity , ,gestational age in weeks , previous CS delivery , and Hb level ( all participant were of Hb level above 10.5 mg \dl). As regards mean blood loss and incidence of PPH ;they were lower in women received carbetocin .
A significant difference was noticed between the three groups as regarding DROP in hemoglobin ,need for additional uterotonics and occurrence of side –effects in favor of carbetocin group.