الفهرس 
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Abstract
Summary
Cesarean section is considered the most common surgical
procedure in the world. The number of operations performed
annually worldwide is estimated by about one million cases.
The type of anesthesia used and the way by which it is
managed by are considered important elements in determining
the outcome of cesarean section as both general and spinal
anesthesia used in cesarean section have advantages and
disadvantages, so there is no completely perfect way of
anesthesia to perform.
The most important factors that determine the type of
anesthesia include; complications associated with pregnancy,
parental choice, urgency of the operation, the experience of the
anesthesiologist, medical history of the mother and the choice
of the obstetrician.
Some studies demonstrated that the amount of blood loss
in women who receive spinal anesthesia in cesarean sections is
less when compared to women who receive general anesthesia,
as well as post-operative pain. Also the ability to move and
walk in women who receive spinal anesthesia is faster than
women who receive general anesthesia.
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However, these results should not be taken into
consideration without further studies and researches to compare
between spinal anesthesia and general anesthesia. Accordingly,
the objective of conducting this research was to evaluate the use
of both general and spinal anesthesia in cesarean section to
determine which one was associated with less blood loss.
This research was conducted on one hundred and fiftyfive
pregnant women carrying single full term infant, between
25 and 35 years old, and did not undergo any previous
operations in the lower abdomen except cesarean sections and
did not have any bleeding tendency, then undergone a cesarean
section after random distribution into the two studied groups,
one with general anesthesia and one with spinal anesthesia.
The first group who had undergone general anesthesia
included seventy-seven pregnant women, while the second
group who had undergone spinal anesthesia included seventy
eight pregnant women.
All circumstances were united in both groups regarding
intravenous fluids and medications used; together with
measuring of blood pressure and other vital data of the women.
Basic data of the study has been recorded including: age, parity,
hemoglobin and hematocrit before, and on third day after CS.
Amount of blood loss has been calculated and recorded using
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107
the acute normovolemic hemodilution equation. Secondary
outcomes has also been recorded including: vital signs, urine
output, the number of fainting and headache attacks, need for
blood transfusion and the elapsed time from the end of the
operation till lactation ,mobilization , passing flatus and ability
to eat and drink.
The mothers were submitted to strict follow up until
discharge from the hospital usually on the morning of third day.
The results showed that the group which had a cesarean
section under spinal anesthesia has a statistically significant 3rd
day post-operative higher level of hemoglobin (P< 0.001),
when compared with general anesthesia, with a mean difference
of 0.660g/dL and also a statistically significant 3rd day postoperative
hematocrit percentage higher with the spinal
anesthesia group with a mean difference of 1.507% (P= 0.002).
By applying of hemoglobin and hematocrit values in the acute
normovolemic hemodilution equation, it was found that women
operated under general anesthesia had more amount of blood
loss than those operated under spinal anesthesia with a mean
difference of 152.760 ml with the use of hemoglobin values and
174.274 ml with the use of hematocrit values.
The results also showed that the spinal anesthesia group
had a significant higher percentage in headache attacks versus
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108
general anesthesia group, lower percentage in blood transfusion
post-operatively versus general anesthesia group, shorter time
till breast feeding with a mean difference of 54.3 minutes,
shorter time till start of ambulation with a mean difference of
69.36 minutes and longer time till first request for analgesia
with a mean difference of 17.646 minutes.
In this study, there were no statistically significant
differences between both groups regarding post-operative; vital
signs, urinary output, fainting attacks, time elapsed from the
end of the operation till passing flatus and the ability to eat and
drink.
As a result of this research, it is recommended to use
spinal anesthesia in cesarean deliveries for convenience and
safety for the mother due to less bleeding and less postoperative
pain.