الفهرس 
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Abstract
Primary postpartum haemorrhage (PPH) is a major cause of maternal mortality, accounting for 6% of all cases worldwide. PPH is caused primarily by the uterus failing to contract after delivery, resulting blood loss of 500 mL or more vaginal delivery, or 1000 mL or more cesarean delivery ; these conditions can occur within the first 24 hours after delivery (primary PPH) or between 24 hours and 6 weeks after delivery (secondary PPH). (Kebede et al., 2019).
Prior PPH, macrosomic baby, parity, prolonged augmented labour, placental abnormalities, anaemia, CS all risk factors atonic PPH, though can occur women identifiable risk factors.
universal prevention PPH, oxytocin widely used effective first-line uterotonic agent. binds myometrium Oxytocin receptors stimulates uterine muscle contraction, increasing intracellular calcium concentration. Because effective 2–3 minutes after injection, few side effects, can used all women, oxytocin preferred over other uterotonic drugs. However, there some limitations use, including fact Oxytocin short half-life few minutes continuous intravenous (IV) infusion required achieve sustained uterine contractions. Also maintenance quality oxytocin problem requires cold storage transport 2-8o C. low-resource settings, cold chain not commonly available. (Fouche-Camargo., 2022).
To reduce occurrence PPH, Misoprostol (a synthetic E1 prostaglandin analogue) added treatment PPH. Misoprostol should administered during third stage labour, shortly after infant’s birth. single 600 ug dose misoprostol should taken oral, vaginal, rectal followed controlled cord traction uterine massage. most common side effects shivering pyrexia. (Taylor et al., 2012).
Carbetocin recently used treat PPH. Carbetocin eight-amino acid analogue oxytocin. binds oxytocin receptors expressed pregnant women’s uterine muscles, causing tetanic uterine contractions about 11 minutes after 8-30ug intravenous administration, followed rhythmic uterine contractions lasting 60 120 minutes. Carbetocin longer duration action than Oxytocin, plasma half-life 40 minutes. Carbetocin intravenous injection causes rhythmic uterine contractions last approximately 60 minutes, whereas IM injection significantly extends activity 120 minutes. (Theunissen et al., 2018).
Carbetocin more heat stable. Carbetocin found stable 30o C 3 years, 40o C 6 months, 50o C 3 months 60o C 1 month. terms side effects, use carbetocin associated substantial reduction vomiting, fever shivering compared misoprostol. (Gallos & Coomarasamy., 2019).