الفهرس | Only 14 pages are availabe for public view |
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. |