الفهرس 
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Abstract
AMTSL as a prophylactic intervention is composed of a package of three components or steps: First, administration of a uterotonic, preferably oxytocin, immediately after birth of the baby; second, controlled cord traction (CCT) to deliver the placenta; and third, massage of the uterine fundus after the placenta is delivered. In 2012, the results of a large WHO-directed, multi-centered clinical trial were published and showed that the most important AMTSL component was the administration of a uterotonic.
The prophylactic use of uterotonics reduces mean blood loss and therefore maternal morbidity and mortality. Although oxytocin was the product of first choice, carbetocin has found its place in modern obstetrics.
Intravenous injection of 10 IU of oxytocin is recommended as the prophylactic medication of choice to reduce the incidence and severity of PPH.
Oxytocin has a short half-life, whereas carbetocin, an oxytocin derivative exerting its effect via the same molecular mechanisms as oxytocin, has a longer half-life, and has been reported to decrease the use of additional oxytocics. Currently 100 µg of carbetocin is routinely used for the prevention of PPH.
This study was done for 6 months, collected data from 120 parturients who were analyzed for reaching the final results. The aim was to compare between the two commonly used uterotonic preparations; oxytocin and carbetocin with respect to the incidence and magnitude of hemodynamic changes, nausea and vomiting in patients undergoing caesarean section under spinal anaesthesia in the operating room, PACU and after transferring the patient to the ward.
Our observational study included only healthy pregnant women with ASA I and II aged between 20 to 35 years old with the exclusion of any patient with factors affecting hemodynamics in order to get best results like placenta previa, placental abruption, preeclampsia, gestational diabetes, cardiovascular diseases, hypothyroidism and hyperthyroidism.
In our study, atonic postpartum hemorrhage occurred in 12 (20%) patients in group A and in 3 (5%) patients in group B, nausea occurred in 4 (6.7%) patients in group A and in 5 (8.3%) patients in group B, vomiting occurred in 2 (3.3%) patients in both groups A and B, bradycardia occurred in 3 (5%) patients in group A and in 4 (6.7%) patients in group B and hypotension occurred in 13 (21.7%) patients in group A and in 9 (15%) patients in group B.
Atonic postpartum hemorrhage was significantly higher in group A than group B (P = 0.025) while nausea, vomiting, bradycardia and hypotension was insignificantly different between both groups (P = 1, 1, 1 and 0.345 respectively).