الفهرس 
Chapter (I): PostPartum Hemorrhage (PPH)Only 14 pages are availabe for public view
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Abstract
Management of the third stage of labour has been an issue of discussion,
concern and continued debate for the past 2 decades, despite the many strategies
employed and the divergent approaches to care, there has not been significant
consistent reduction in the postpartum hemorrhage (PPH) rates reported in
industrialized countries in recent times.
Despite evidence that active management of the third stage of labour
reduces the incidence of PPH, defined as blood loss more than or equal 1000 ml
and/or the need for blood transfusion within 24 hours of delivery, expectant
management is still widely practiced, factors accounting for this situation
include the desire for more natural experience of childbirth, the philosophy that
active management is unnecessary in low-risk women and avoidance of the
adverse effects of conventional uterotonic agents.
Uterine atony is the first cause of hemorrhages at the time of delivery. So
its prevention and treatment are to be considered within a context of public
health. Postpartum hemorrhage is indeed one of the main causes of maternal
mortality. Thus, the need for decreasing the rate of PPH is today a concern for
all the obstetric units.
To face it, the mean tools on which we count are the improvement of
monitoring, the definition of strategies based on standardized protocols and
prophylactic treatment having an effective contractile action on the uterus.
A long-acting oxytocin analog, 1-deamino-1-monocarba-(2-Omethyltyrosine)-
oxytocin, carbetocin , is indicated in the prevention of uterine
atony following delivery by CS under spinal or general anesthesia.
Summary
Our study was observational study that was conducted at Menuofia
University Hospital including 100 women who underwent caesarean section
from January 2022 to April 2023 held in Obstetric operating room at Menoufia
University Hospital, after ethical approval by Echical Committee of scientific
research of Faculty of Medicine, Menoufia University and informed written
consent was taken from all participants.
Our study was conducted on 100 patients underwent CS with high risk for
postpartum hemorrhage and classified into 2 groups:
group 1: included 50 women who received carbetocin (100mcg/ml
ampoule) as a bolus of 100 μg IV diluted by 10cm of 0.9 normal saline over one
minute after delivery of the anterior shoulder of the fetus.
group 2: included 50 women in the control group received 10 IU of
oxytocin added to 500ml of 0.9 normal saline for continuous intravenous
infusion by rate 8 ml / min for an hour after delivery of the anterior shoulder of
the fetus.
Aiming to compare the haemodynamic effects of oxytocin and carbetocin
(effects on blood pressure and diuresis), assess the efficacy of these drugs in
terms of intraoperative blood loss, any surgical interventions, additional
uterotonic drugs, incidence of PPH and need for blood transfusion at high risk
patients for postpartum hemorrhage. All patients were subjected to complete
detailed personal and medical history, complete gynecologic and obstetric
history, general examination including vital signs also, SBP & DBP
preoperative and postoperative at different intervals, systems review including
examination of different systems, laboratory investigations including
preoperative routine investigations (CBC, liver function tests, kidney function
Summary
tests, coagulation profile, virology), ultrasound examination for demonstration
of (fetal age, fetal number, fetal position, fetal weight, amniotic fluid index and
the location of the placenta), postoperative haemoglobin and haematocrit levels
at different intervals for follow up, postoperative estimation of blood loss and
follow up.
Our results declared that carbetocin is almost similar to oxytocin for
maintaing adequate uterine tone, no need for additional uterotonic drugs , no
need for blood transfusion and decrease incidence of PPH, with similar safety
profile and minor side effects in the third stage and in the first 24 hours after
delivery, but there is decrease in intraoperative blood loss with carbetocin than
oxytocin also, carbetocin has a higher cost than oxytocin.