EFFECTIVENESS OF INTRAVENOUS TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING AND AFTER CESAREAN SECTION; A DOUBLE BLINDED, RANDOMIZED, CONTROLLED TRIAL

Abstract

SUMMARY P rimary post-partum hemorrhage (PPH) is defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. According to national statistics in Egypt, Hemorrhage before and after delivery was the leading direct cause of maternal death (43%), with most hemorrhage deaths due to postpartum hemorrhage. There were 32 maternal deaths with hemorrhage per 100,000 live births. Figures for other causes were much less than hemorrhage (e.g. hypertensive diseases were 18 per 100,000, for sepsis 7 per 100,000, for ruptured uterus 7 per 100,000, for cesarean section 6 per 100,000, for obstructed labor 4 per 100,000, for cardiac disease 11 per 100,000 and for anemia 9 per 100,000). The increased frequency of PPH in the developing world- which is reflected by the rates given above - is mainly due to expectant management because of lack of availability of medications used in the active management of the third stage. Thus our study was held on the steps of previous studies to assess the effectiveness of tranexamic acid in reducing blood loss in patients undergoing cesarean sections. In the current study a double blinded, randomized, controlled trial was carried out on 200 women attending the labor ward in Ain Shams university maternity hospital to undergo an elective cesarean section. 100 of the patients received tranexamic acid 20 minutes before induction of anesthesia in addition to oxytocin after delivery of the baby; the other 100 patients received oxytocin only. The patients were monitored for the occurrence of postpartum hemorrhage in the form of intra-operative blood loss, post-operative vaginal bleeding, also drop in hemoglobin and haematocrit 24 hours postoperative. In the current study, no significant difference between Study and Control groups as regards age (p0.526). In the current study, no significant difference between Study and Control groups as regards Gestational age (p0.820). In the current study, amount of blood loss from placental delivery till end of operation (p<0.001) and total blood loss (p<0.001) was significantly lower in study group than control group. In the current study, Vaginal bleeding in the 1st2 hours post-partum was significantly less severe in study group than control group (p<0.019). In the current study no significant difference between Study and Control groups as regards Preoperative Hemoglobin (p0.195), Postoperative Hemoglobin was significantly higher in study group than control group (p<0.001), Reduction in Hemoglobin was significantly less in study group than control group (p<0.001). In the current study no significant difference between Study and Control groups as regards Preoperative Hematocrite (p0.967), Postoperative Hematocrite was significantly higher in study group than control group (p0.015), Reduction in Hematocrite was significantly less in study group than control group (p<0.001).