الفهرس 
POSTPARTUM HEMORRHAGEOnly 14 pages are availabe for public view
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Abstract
Background: Cesarean section (CS) is one of the most frequently performed operative interventions worldwide. Cesarean section rates increase each year throughout the world. Cesarean delivery can lead to some serious maternal and fetal complications including primary postpartum hemorrhage (PPH). Primary postpartum hemorrhage (PPH) is defined as a cumulative blood loss more than 1000ml following cesarean delivery or any amount of blood loss within 24hours after birth evidenced by a rise in pulse rate, and falling blood pressure.
Aim of the Work: This study was conducted and aimed to compare the safety and effectiveness of preoperative versus postoperative misoprostol for decreasing the primary postpartum hemorrhage following caesarean section comparing with routine prophylactic regimen of oxytocin.
Patients and Methods: This prospective interventional study was conducted at Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from February 2022 until April 2023. During this study, 300 pregnant women admitted to the hospital for elective cesarean section.
Results: Our study revealed that preoperative rectal misoprostol was more effective than postoperative rectal misoprostol and routine prophylactic regimen of oxytocin in decreasing the primary postpartum hemorrhage following elective caesarean section. Postoperative hemoglobin (12.16 ± 1.81 vs. 10.82 ± 1.32 vs. 10.05 ± 1.2) g/dl and hematocrit levels % (31.74 ± 2.33 vs. 30.92 ± 3.21 vs. 29.87 ± 3.56) were statistically significant higher, intraoperative blood loss (ml) (607.5 ± 176.26 vs. 620.8 ± 157.22 vs. 676.5 ± 204.98), postoperative vaginal bleeding, amount of 1st 24hr post-partum blood loss (ml) (190.5 ± 25 vs. 240.5 ± 27.15 vs. 300.5 ± 30.26), hemoglobin (g/dl) (0.31 ± 0.23 vs. 1.59 ± 1.11 vs. 2.31 ± 1.71) and hematocrit drops % (0.43 ± 0.31 vs. 1.86 ± 1.30 vs. 2.40 ± 1.78) were statistically significant lower among cases of preoperative rectal misoprostol group compared with postoperative rectal misoprostol and routine prophylactic regimen of oxytocin groups. On the other hand, no differences were noted between study groups as regard intraoperative uterine atony, need for additional intraoperative oxytocin, need for additional intraoperative ergometrine, need for blood transfusion, need for bilateral uterine artery ligation, need for hysterectomy, need for additional postoperative oxytocin, duration of surgery and duration of hospital stay.
Conclusion: Preoperative rectal misoprostol is advised to be used in prevention of postpartum hemorrhage in women undergoing elective cesarean section.