Buccal Misoprostol During Cesarean Section for Preventing Postpartum Hemorrhage

Inclusion Criteria: * Women who underwent delivery either by elective or emergent cesarean section at 24 week gestation or later with preoperative levels of hemoglobin and hematocrit determined up to 72 hours prior to delivery. The patients must have at least one of the risk factors for uterine atony listed below: 1. Fetal macrosomia (estimated fetal weight ≥ 4 Kilos) diagnosed by clinical measurement (Johnson´s technique) or ultrasound measurement (Hadlock´s formula). 2. Polyhydramnios (defined as Phelan´s amniotic fluid index \> 24 cm) 3. Twin or Multiple pregnancy. 4. Prolonged labour (prolonged active phase \> 12 hours) or precipitate labour(cervical dilatation ≥ 10 cm/hour). 5. Magnesium sulphate or any other tocolytic agent therapy for ≥ 8 hours before cesarean section. 6. Intravenous oxytocin therapy for at least 4 hours before cesarean section. 7. Multiparous women (≥ 3 prior abdominal or vaginal deliveries ) 8. Clinical chorioamnionitis was defined as maternal temperature of ≥ 38°C in addition to more than one of the following criteria: fetal tachycardia (\> 160 beats per minute), maternal tachycardia (\>100 beats per minute, maternal leukocytosis (15,000 cells/mm3), uterine tenderness or foul smelling amniotic fluid. 9. Known myomatosis, uterine Müllerian malformations or those diagnosed by ultrasound. Exclusion Criteria: 1. Misoprostol incorrect administration 2. Severe allergic, bleeding disorders (e.g., haemophilia); severe asthma or any other absolute contraindication to misoprostol use. 3. Any bleeding occurred before delivery (abruptio placentae, placenta praevia) or bleeding due to other causes different than uterine atony.