Introduction
PPH, haemorrhage, hypovolemia, blood loss
BLOOD LOSS, HAEMORRHAGE, SECONDARY, POSTPARTUM HAEMORRHAGE
The cesarean section (CS) rate is still sharply growing, as CS is the commonest major obstetric procedure performed worldwide [Postpartum haemorrhage (PPH), either primary or secondary, is considered one of the commonest types of obstetric haemorrhage. In 2017, the American College of Obstetrics and Gynecology updated the definition of primary PPH to be a cumulative blood loss higher than 1000 mL with clinical features of hypovolemia within 24 h of birth, regardless of the delivery route [Since prevention of PPH is the cornerstone of management, the National Collaborating Centre for Women’s and Children’s Health has recommended the administration of intravenous 5 IU of oxytocin routinely following the cesarean delivery as a prophylactic measure against PPH [Several studies have assessed the use of other agents in addition to oxytocin for the prophylaxis against PPH following CS. Misoprostol, a prostaglandin E1 analogue, has been introduced as a uterotonic agent to prevent PPH after CS. A Cochrane review has concluded that the combination of misoprostol and oxytocin was one of the most effective combinations in reducing blood loss compared to oxytocin alone [Tranexamic acid is an antifibrinolytic medication that acts by blocking lysine binding sites on plasminogen molecules. Several studies have addressed its use in preventing PPH following CS and showed the effectiveness of tranexamic acid when added to oxytocin in preventing blood loss [Our study aimed to reach the most effective protocol in reducing intra and post-operative blood loss in high-risk women for PPH following CS. Therefore, we compared the effectiveness of the combined use of sublingual misoprostol and IV oxytocin with that of the combined use of IV tranexamic acid and oxytocin. Also, we compared them with the effectiveness of oxytocin when given alone.