الفهرس 
- Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Caesarean section is one of the most commonly performed major operations in women through out the world. Rates are escalating, with studies from the United States of America, the United Kingdom and China reporting rates between 20%and 30% (Martin et al., 2002).
The demographic and health survey in Egypt 2004 were approved that The hospital caesarean section rate was 22% in Egypt. Variations by place of delivery were evident, although determinants of caesarean section characteristics were more important in
Postpartum hemorrhage is defined as a blood loss of more than 1 000 mL in the first 24 h following cesarean delivery(Adamson et al., 2008)
Postpartum hemorrhage (PPH) is leading cause of maternal morbidity and mortality world wide and the number of maternal deaths due to ppH is estimated to exceed 100,000 each year (Mousa et al., 2009)
Misoprostol (15-deoxy-l 6hydroxy-16-metliyl prostaglandin El [PGE1]) is asynthetic PGE1 analog, originally intended for use to prevent nonsterodial anti -inflammatory drug (NASID)-induced gastric ulcers (Watkinson et al.,1988). Owing to uterotonic properties, its has become one of the most useful druges in obstetrics (Chong et al., 2004).
The drugs low cost, ease of administration through multiple routes, stability, and safety profile make it a good option in resource —poor setting (Derman et al., 2006),and in patients who are vomiting unable to take medications, or under anesthesia (Kwast et al., 1986).
This study will be done to determine the best time of administration of misoprostol rectally during cesarean section and its role in reducing blood loss. postpartum hemorrhage (PPH) continues to be the leading cause of maternal morbidity and mortality worldwide and that is according to the estimates of the World Health Organization in 1998. Average blood loss during delivery progressively increases with the mode of delivery, vaginal delivery (500 ml), cesarean section (1000 ml) and emergency hysterectomy (3500 ml) of blood.
Excessive blood loss as estimated by a 10% DROP in hematocrit post-delivery or by need for blood transfusion, occurs in approximately 4% of vaginal deliveries and 6% of cesarean births.PPH has many potential causes, but the most common by a wide margin is uterine atony i.e. failure of the uterus to contract and retract following delivery of the baby. PPH in a previous pregnancy is a major risk factor and every effort should be made to determine its severity and cause. A reduction of operative blood loss at cesarean section is beneficial to the patients in terms of decreased postoperative morbidity and a decrease in risks associated with blood transfusions. The routine use of misoprostol is associated with a significant reduction in the occurrence of postpartum hemorrhage.
In countries with high incidence of anemia among pregnant women either due to nutritional or environmental factors, even a relatively small reduction of postpartum blood loss would be a significant measure relevant clinically.
Different management protocols for prevention of PPH have been used and these are being continuously revised to achieve improved success rates and reduce discomfort to the patients.
The third stage of labor is potentially the most dangerous part for the mother, and actve management is necessary. i.e.(administration of a uterotonic medication before the placenta is delivered, early clamping and cutting of the umbilical cord, and application of controlled traction to cord) The main risk is the occurrence of post partum hemorrhage PPH is the most common cause of maternal morbidity and mortality worldwide. In developing countries the PPH is the main cause of maternal deaths which defined as bleeding from the genital tract of 500 ml or more in the first 24 hours following delivery of the baby. Uterine atony is the most common cause of immediate heavy PPH.