Background
umbilical cord prolapse, death, bleeding, pelvic deformity, eclampsia, hemorrhage, rupture
BLEEDING, CHORIOAMNIONITIS, POSTPARTUM HEMORRHAGE, CONTRACTIONS, ECLAMPSIA, CONTRACTION, HEMORRHAGE, POSTPARTUM BLEEDING, PLACENTA PREVIA, UTERUS
The rate of cesarean section (CS) is increasing worldwide. The total number of CS was 29.7 million births in 2015 which was the double estimated number in 2000 (16 million) [The CS saves the lives of the fetus and the mother and decreases the risks of morbidity and mortality especially if the vaginal delivery is complicated and the indication of CS is absolute as in pelvic deformity, an abnormal lie of the fetus, chorioamnionitis, rupture of the uterus, placenta previa, umbilical cord prolapse, and eclampsia [Obstetric hemorrhage affects negatively the mother's health and can lead to death which represents about 27% of the total causes of maternal death in the world, while postpartum hemorrhage alone accounts for 19.7% [Women undergoing emergency CS have a higher risk of severe postpartum hemorrhage [Normally some mechanisms occur to decrease intrapartum and postpartum bleeding. At the end of delivery, the placenta separates and the uterine wall undergoes changes to decrease the amount of bleeding like strong muscular contraction, platelet activation, and increasing release of coagulation factors while the fibrinolysis increases [Oxytocin increases muscular uterine contractility and intravenous 5 IU after fetal delivery is sufficient to induce these contractions and decrease bleeding [The difference in efficacy of oxytocin alone compared to the efficacy of the combination of tranexamic acid and ethamsylate is uncertain and a limited number of clinical trials was performed to compare their action. That is why we performed this clinical trial to compare them in reducing the intra-operative bleeding amount in women who undergo elective or emergency CS.