الفهرس 
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Abstract
Summary
Obstetric hemorrhage remains one of the major causes of maternal death in both developed and developing countries.Primary postpartum hemorrhage (PPH) is the most common form of major obstetric hemorrhage. The traditional definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24 hours of birth of a baby.
Many methods could be used to reduce amount of intraoperative bleeding during third stage of labor and can also decrease postoperative blood loss for example intravenous oxytocin infusion or methergine or misoprostol administration. Misoprostol is a synthetic analogue of prostaglandin E1 that acts as a uterine contractile agent. It is effective in preventing and treating post-partum bleeding. Tranexamic acid (TXA), a synthetic lysine-analogue antifibr-inolytic, it acts by binding to plasminogen and blocking the interaction of plasmin(ogen) with fibrin, thereby preventing dissolution of the fibrin clot.
The current study was a randomized cohort study aimed to compare the efficacy and safety of preoperative Tranexamic Acid versus rectal Misoprostol in the reduction of blood loss during and after elective lower segment cesarean delivery among high risk and low risk patients.
this study conducted at department of Obstetrics and Gynecology – benisuef unvirsty Hospital- Faculty of Medicine- benisuef University where 200 pregnant women attending for elective cesarean delivery were randomly allocated to two groups First group is high risk group ,second group is low risk group ,then each group is subdivided into 2groups one of them is misoprostol group(received 400 microgram rectal misoprostol )and the other is tranexamic acid group(received1 gm(10 ml)(2amp) Tranexamic acid).In all groups, Following the delivery of the baby, All patients additionally received an intravenous bolus of 10 IU oxytocin(Syntocinon)&additional ecbolics(inform of10IUoxytocin& IM ergometrin)only if blood loss exceeded 500ml or on demand of the operating surgeon.At the end of the operation, the amount of bleeding was assessed and Post partum blood loss during the first 24hours after surgery was assessed by weighing pads.
There was no statistically significant difference between groups according to their baseline characteristics regarding maternalAge (years), BMI (Kg/m2) and Gestational age.
In our study ,no significant difference in EBL among studied groups ,In high risk misoprostol group(583.6ml),,in low risk misoprostol group(516,8),, in high risk TXA group(647ml),,in low risk tranexamic acid group(529,109ml)
Also, there was no statistically significant difference among the 4 studied groups regarding the occurrence of postpartum blood loss >1000ml in the first 24 hours, the need for blood transfusion or the use of additional ecbolics furthermore,,the most common cause of high risk atony was macrosomia followed by twins .
There was no statistically significant difference among the studied groups regarding the Apgar score at 1 minute , at 5 minutes or regarding neonatal weight.