الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
As postpartum haemorrhage is a major contributor to maternal morbidity and mortality worldwide, Oxytocin is routinely administered during elective Caesarean delivery (CD) to initiate and maintain adequate uterine contractility after placental delivery. The uterotonic effect of oxytocin is important in reducing blood loss and decreasing the risk of postpartum hemorrhage. However oxytocin has many adverse effects which are dose related like decrease in blood pressure, increase in heart rate and occurrence of nausea and vomiting.
The aim of this work was to compare three different bolus doses of oxytocin; 1 unit, 3 units and 5 units as regards haemodynamic changes, incidence and severity of nausea and vomiting, blood loss, uterine tone and the need for additional uterotonics to produce adequate uterine tone during elective Caesarean section under spinal anaesthesia.
The study was done on 150 healthy full term parturients aged between 18-40 years old, ASA physical status I and II undergoing elective CS under spinal anaesthesia were enrolled in this study which was carried out in Elshatby university hospital. After approval of Ethics Committee of the faculty of medicine, the High Institute of Public Health for the sample size and taking a written informed consent from each patient were randomly categorized using closed envelope technique into 3 equal groups, 50 patients each.
Group I: received I.V bolus of 1 unit of oxytocin after delivery of the fetus.
Group II: received I.V bolus of 3 units of oxytocin after delivery of the fetus.
Group III: received I.V bolus of 5 units of oxytocin after delivery of the fetus.
Preoperative evaluation was done by complete history taking, physical examination and necessary laboratory investigations.
Before starting the spinal anaesthesia basic monitoring was applied to the patients including electrocardiogram (ECG), noninvasive blood pressure and pulse oximetry.
Baseline readings were measured before starting oxytocin administration.
Spinal anaesthesia was performed at the Lumbar (L) 3–4 interspace while the patient in the sitting position by a 25 gauge Quinke spinal needle with 2ml hyperbaric bupivacaine 0.5% . The patient then has been moved to the supine position with left lateral uterine displacement.
Surgery was allowed to proceed after achieving a T4 sensory level. normal saline were being infused during the intraoperative period, with the aim of using a total crystalloid volume of 1 liters.
MABP, HR was recorded at the following intervals:
• Pre-spinal.
• 5 minutes Post-spinal.
• Before giving oxytocin as a baseline for subsequent changes.
• Every 3 minutes interval for 30 minutes after oxytocin bolus.
• At the end of the operation.
Uterine tone was assessed by the obstetrician at 5, 10, 15 and 20 min on a five-point scale (1= atonic, 2= partial but inadequate uterine contraction, 3= adequate contraction, 4= well contracted, 5= very well contracted by manual palpation of the uterus), and accordingly the need for more uterotonic drugs.
Incidence of nausea and/ or vomiting, was recorded both before and after the oxytocin bolus.
There was no significant difference between the three groups regarding age, weight or ASA classification.
There was significant decrease in MABP between the three groups which was much evident in 5 units group than 3 units group than 1 unit group
There was significant increase in the HR between the three groups which was much evident in 5 units group than 3 units group than 1 unit group
Also as regard incidence of nausea and/or vomiting there was a significant difference between the 3 groups with increased incidence in the 5 units group than others.
The 3 groups achieved almost the same degree of satisfactory uterine contraction with no significant difference between them at all measured intervals. Also there was no significant difference in need for additional uterotonic drugs.