الفهرس 
Acknowledgments
Caesarean section rates and indicationsOnly 14 pages are availabe for public view
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Abstract
The prevalence of deliveries by CS has been steadily increasing worldwide over the last few years. The incidence of respiratory morbidity has been reported to be significantly higher in neonates delivered by caesarean section before the onset of labor than in those delivered by caesarean section during labor. Proposed mechanisms for the association between cesarean delivery and respiratory morbidity include iatrogenic prematurity with surfactant deficiency and an attenuation of the fetal catecholamine surge during labor.
Misoprostol is a synthetic PGE1 analogue, widely used for labor induction which can be administered by several routes . when used vaginally it starts to act in 20 minutes its T max is 70minutes
Aim of the work:
To determine if vaginal administration of misoprostol can improve the neonatal respiratory outcome when given within 60 to 90 minutes before the planned or pre labor cesarean section at 34 – 37 weeks gestational age .
Patients and methods.
It is a randomized controlled clinical study done in Women Health Centre, Obstetrics & Gynecology department, Assiut University .
Inclusion criteria:
All pregnant women who are planned for elective (planned& pre labor) cesarean section at 34 -37 weeks gestation .
Exclusion criteria:
1- Pregnancies with known fetal malformation/s or chromosomal aberrations.
2- Presence of absolute contraindication for use of misoprostol.(i.e known hypersensitivity to the drug)
3- Multiple pregnancies.
4- Women before 34 and after 37 weeks gestation .
5- Non reassuring cardiotocogram immediately before recruitment.
6- Failure to obtain an informed consent.
Primary outcomes:
1- Rate of respiratory distress in neonates
2- Apgar score of newborn.
3- Need for mechanical ventilation of the neonate either by Ambu resuscitator or endotracheal intubation.
4- Need for NICU admission and duration.
Sample size :
292 women included in the study , 146 women in the study group ( received vaginal misoprostol) and 146 women in the control group (received nothing).
Results:
Women of both groups met the inclusion and exclusion criteria mentioned before. They had no significant difference regarding their basic clinical data as age , parity ,gestational age at recruitment , number of previous CS, indication of CS, steroid administration for lung maturity and mean time from recruitment to surgery. The overall rate of neonatal respiratory distress was significantly lower in the study group than in the control group 15 % and 30.2 % respectively.
Incidence of neonatal tachypnea was 22 % in the misoprostol group and 38 % in the control group. Four newborns in the control group needed endotracheal intubation none of the misoprostol group needed intubation.
Sixteen newborns in the study group (11%) and nineteen in the control group (13%) needed NICU admission .
Conclusion:
The vaginal misoprostol before pre labor cesarean section between 34 and 37 weeks gestational age may decrease the risk of neonatal respiratory problems .This protective effect is mainly on the mild form of respiratory distress as Transient Tachypnea of the Newborn (TTN). Misoprostol has this independent protective effect regardless of steroid administration and gestational age in this group of women .