Efficacy of Carbetocin Versus Oxytocin Plus Misoprostol in Decreasing Blood Loss During Cesarean Section

The aim of this clinical trial is to test if carbetocin is as effective as oxytocin plus misoprostol in decreasing intraoperative blood loss in women undergoing planned cesarean section.The main question it aims to answer is:* Is carbetocin as effective as oxytocin plus misoprostol in decreasing intraoperative blood loss in women undergoing planned cesarean section?Researchers will compare 2 groups:women receiving Oxytocin plus Misoprostol;women receiving Carbetocin as regards:estimated blood loss

Inclusion Criteria:Pregnant women planning to deliver by CS.Age between 18-40.Gestational age: (36-42 weeks).Exclusion Criteria:Women in active labour.Rupture of membranes more than 24 hours &/or intraamniotic infection.Suspected extensive adhesions eg: more than P3CS, endometriosis, previous pelvic surgery.Antepartum hemorrhage and abnormal placentation e.g.: low lying placenta, placenta previa, placenta accreta.Major intrapartum hemorrhage more than 1000 ml.History of postpartum hemorrhage.Anemia (Hb level less than 10g/dl).Uterine overdistention eg: polyhydramnios, macrosomic baby, multiple pregnancy.Known allergy to any of misoprostol, oxytocin, carbetocin.Known medical disorders: Diabetes Mellitus, hypertensive disorders, Systemic Lupus Erythematosus.Known coagulopathy problem.Contraindication &/or refusal to spinal anesthesia.