الفهرس 
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Abstract
Postpartum hemorrhage (PPH) is the most common cause of maternal morbidity and mortality worldwide. Uterine atony is the most common cause of immediate heavy PPH.
Management of primary PPH includes prophylactic, conservative, medical, mechanical, and surgical measures. Medical measures include [uterine massage, resuscitative measures, oxytocin,carbetocin(long-acting synthetic analogue of oxytocin ), prostaglandins analogue and ergometrine]
The aim of this randomized study is to compare the effectiveness and adverse effects of I.V carbetocin as a long acting oxytocic drug and a oxytocin I.V for prevention of postpartum haemorrhage (PPH) following cesarean delivery as regards efficacy and safety of each drug and needing for additional uterotonic drugs
Grouping: 100 women included in this study were randomly divided into two groups . group (A): including 50 patients who received carbetocin 100 μg I.V after delivery of the baby.
group (B): including 50 patients who received oxytocin 5 I.U. I.V after delivery of the baby.
We compare between the two groups using computer programs to evaluate the safety and efficacy of each drug and needing for additional utero tonic drugs
Summary
80
In our study, the surgeon was blinded to the drug given to produce uterine contraction following delivery of the baby, and he is the best one to decide if there is a need to add more uterotonic doses in an unbiased manner.
In this study, the need for additional uterotonic agents to produce proper uterine tone was significantly higher in the oxytocin group compared to the carbetocin group. These results are consistent with previous studies that reported significantly higher need for additional uterotonics in the oxytocin group compared with the carbetocin group
In our study, the median time needed to add uterotonic agents was significantly higher in the carbetocin group than in the oxytocin group. This can be explained by the longer half life of carbetocin as compared with oxytocin. This was also similar to Dansereau et al, who reported longer time needed to intervention in the carbetocin group compared to the oxytocin group .
Carbetocin is well tolerated, and the monitoring up to 24 hours after the administration showed a great hemodynamic stability, comparable with that of oxytocin
Regarding difference in preoperative and postoperative haemoglobin our study showed a statically significant difference with minimal decrease in carbetocin group in comparison with oxytocin group.
Regarding estimated blood loss the mean blood loss in carbetocin group was 728ml with SD 326.3 and 939ml with SD of 322.3 in oxytocin group this shows a highly significant difference.
Summary
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The incidence of post partum haemorrhage in carbetocin group was 12% mild PPH and 6% moderate PPH on the other hand 28% mild PPH and 8% moderate PPH in oxytocin group which is a statistically significant difference there were no cases with severPPH in both groups.
In our study, adverse effects for carbetocin were similar for frequency and nature to those observed with oxytocin. Some adverse effects observed in this study as flushing, heat sensation and metallic taste were observed previously during clinical pharmacology studies with carbetocin , and probably represent side effects of the drug. However, nausea and vomiting observed in the postpartum ward may be due to the use of meperidine as analgesic after the cessation of the effect of anesthesia. Also, headache may be related to spinal anesthesia rather than a true side effect of the uterotonic drug. Moreover, abdominal pain may be due to uterine contractility rather than a side effect of carbetocin or oxytocin. It is rather a sign that the drug is effective on uterine tonicity and the required objective is achieved.