الفهرس | Only 14 pages are availabe for public view |
Abstract elivery by cesarean section is one of the most commonly performed obstetrical operations all over the world, but it exposes women to the inherent risks of major abdominal surgery, e.g., injury to the pelvic structures, infection, and the need for blood transfusion. Antepartum physiological adaptation in preparation for blood loss at delivery includes a 42% increase in plasma volume and a 24% increase in red blood cell volume by the third trimester. Toward the end of pregnancy, the uterus is perfused at a rate of 500-700 ml –min. This massive physiological hyperperfusion results in an average blood loss of approximately 1000 ml during cesarean delivery. Studies of the relationship between placental delivery mode and intraoperative blood loss have been carried out. It was found that manual removal of the placenta was associated with greater operative blood loss compared with spontaneous separation of the placenta. In contrast, it was recently observed no significant difference, however, these authors studied a relatively small number of patients, some of whom received a midline incision which causes a greater blood loss than a low transverse incision. |