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Abstract
Objective: The aim of study is to detect the effect of insertion of 400 micrograms rectal misoprostol given preoperatively 15 minutes prior to skin incision to reduce amount of intraoperative and early postoperative blood loss during elective repeated lower segment caesarean section. Study design:Double blinded randomized interventional prospective controlled study showing impact of preoperative rectal 400 microgram misoprostol on operative and postoperative blood loss in women with previous one caesarean section undergoing elective repeated lower segment caesarean section, The Study included 200 women undergoing elective cesarean delivery under spinal anesthesia, patients included in the study will be randomized into 2 groups: group (A) (Study group): 100 women who will receive 400 micrograms rectal misoprostol preoperatively 15 minutes prior to skin incision and receiving the standard treatment in form of 20 IU oxytocin drip on 500 ml lactated Ringer’s solution over half an hour immediately after delivery of the neonate. group (B) (Control group): 100 women who will receive only the standard treatment in form of 20 IU oxytocin drip on 500 ml lactated Ringer’s solution over half an hour immediately after delivery of the neonate. Results: There was statistically significant difference between both groups where the Studygroup showed lower levels than Control group in the mean intraoperative blood loss and mean postpartum blood loss (491 ±252 ml and 169.3 ± 81 ml versus 632.8 ±285.9 and 282.1 ±169.1 ml respectively, (P>0.001)), and there was statistically significant difference in percentage decrease in haemoglobin and haematocrit pre and postoperative in Control group more than Study group (14.38 ±3.67% and 36.27 ±6.2% versus 10.83 ±3.39% and 14.86 ±6.46% respectively, (P>0.001)), Also, there was statistically significant difference in percentage decrease in mean arterial pressure (MAP) pre and postoperative in Control group more than Study group (17.49 ±4.1% versus 11.44 ±3.91% respectively, (P>0.001)), and there was statistically significant difference in percentage increase in pulse pre and postoperative in Control group more than Study group (25.6 ±5.58% versus 11.98 ±4.93% respectively, (P>0.001)) Also, the need of additional uterotonics was significantly higher in Control group than Study group (21% versus 7% respectively, (P>0.001)), andpostoperative shivering and pyrexia was statistically higher in Study group than Control group (17% in study group versus 5% in control group,(P>0.001))