trial of 3 protocols to determine the best one to control blood loss during caesarean section

The study population will be divided into 3 groups each containing 200 women:

Group (A): 200 patients will receive 5-IU oxytocin bolus over 3 minutes after delivery of the baby.

Group (B): 200 patients will receive 5-IU oxytocin bolus over 3 minutes and 30-IU oxytocin infusion in 500 ml 0.9 % saline over 4 hours after delivery of the baby.

Group (C): 200 patients will receive misoprostol 800 micrograms intrauterine, placed manually on the bottom of the uterine cavity after delivery of the placenta and cleaning of the cavity.

Operative blood loss will be estimated in theatre based on the volume in the suction bottle and the weight of swabs used. We will record blood loss up until the time the woman will be discharged from the theatre recovery ward.

Hemoglobin level and haematocrit value will be done as follow:-

1. After admission of each case in the pre-operative period.
2. Immediately post- operative.
3. 24 hours post- operative.

Inclusion Criteria:

• Patients booked for elective cesarean section.
• Singleton pregnancies.
• Primigravida or multipara ,first cesarean section or previous .

Exclusion Criteria:

• Patients with obstetric hemorrhage.
• Uterine laceration.
• Placenta previa.
• Blood dyscrasias.
• Large fibroids.
• Multiple pregnancy.
• Pre-eclampsia.
• Marked maternal anemia.
• Previous history of PPH.