الفهرس 
PATIENTS AND METHODS
Inclusion criteriaOnly 14 pages are availabe for public view
Abstract
The study included one hundred forty pregnant women
undergoing elective lower segment cesarean section at term (completed
37 weeks of gestation or more) under regional anesthesia (although
general anesthesia is a risk factor for atonic postpartum hemorrhage, it
was excluded for standardization of cases). Patients who had one or
more of the following criteria were included in the trial (risk factors for
atonic postpartum hemorrhage): Over distended uterus (multiple
pregnancy, polyhydramnios, fetal macrosomia or uterine fibroid), use of
uterine relaxant drugs during pregnancy, grand multiparity (more than 5
delivaries) and Previous postpartum hemorrhage.
Divided into two groups: group one included seventy women
received Carbetocin (Ampoule 100 μg/ml) diluted in 10 ml normal
saline and administered slowly (over 30– 60 seconds) intravenously just
after delivery of the neonate during CS and group two included seventy
women received Misoprostol 800mcg (4 tablets) rectal immediately
before caesarean section.
The current study showed a significant difference between the
two study groups as regard the need for additional uterotonics (pvalue0.001), in misoprostol group was 20.0% (14 cases), in carbetocin
group was 2.9% (2 cases). The current study showed a significant difference between the
two study groups concerning the need for uterine massage (p-value
0.001), in misoprostol group: was 40.0% (28 cases), in carbetocin
group: was 14.3% (10cases).
The current study showed a significant difference between the
two study groups concerning uterine tone after treatment (p-value
<0.0001), misoprostol group: presented by inter-quartile range ( IQR 2
– 3), carbetocin group: presented by inter-quartile range (IQR 3 – 4).
The current study showed a significant difference between the two
study groups as regarding the abdominal pain and fever, heat sensation
and shivering.
The misoprostol group showed statistically significant difference
as more women complained from heat sensation, shivering and fever. In
misoprostol group complained from heat sensation 31.4% (22 cases) (pvalue0.008), shivering 37.1% (26 cases) (p-value0.002) and fever 38.6%
(27 cases) (p-value0.001).
The Carbetocin group showed only statistically significant
difference as more women complained abdominal pain. In carbetocin
group: more women complained from the abdominal pain 81.4% (57
cases) (p-value<0.001).
The current study showed no significant difference between the
two study groups in the incidence of atonic postpartum hemorrhage (p-value 0.493), in misoprostol group: was 8.6% (6 cases), in carbetocin
group: was 4.3% (3 cases).
According to blood loss for the women involved in this study,
mild blood loss <500ml ( in misoprostol group: 47.1% (33 cases), in
carbetocin group: 70.0% (49 cases) that showed more women in the
carbetocin group showed mild blood loss but statically insignificant,
moderate blood loss 500-1000ml : ( in misoprostol group: 44.3% (31
cases), in carbetocin group: 25.7% (18 cases)), excessive blood loss
>1000ml :( misoprostol group: 8.6% (6 cases), carbetocin group: 4.3%
(3cases)), that showed more women in the misoprostol group
complicated by moderate and sever blood loss but this difference was
statistically insignificant.
The current study showed no significant difference between the
two study groups as regard the DROP in hemoglobin (g/dl) (p-value
0.346), in misoprostol group: was the mean DROP 1.34, SD 0.84, in
carbetocin group: was mean DROP 1.23, SD 0.67.
The current study showed no significant difference between the
two study groups concerning the need for blood transfusion (p-value
0.366), in misoprostol group: was 5.7% (4 cases), in carbetocin group:
was 1.4% (1case).