Efficacy of Tranexamic Acid In Reducing Blood Loss Among Pregnant Women During Cesarean Section Because of Placenta Previa

Abstract

Summary P lacenta praevia is a potentially severe obstetric complication where the placenta lies within the lower segment of the uterus, presenting an obstruction to the cervix and thus to delivery. The prevalence of placenta previa has been recently estimated to be approximately 0.5% of all pregnancies, and this increase correlates to the elevated cesarean section rate. Placenta previa is a major cause of maternal morbidity and mortality because of the associated massive antepartum and intrapartum hemorrhage. In order to reduce maternal mortality and morbidity caused by bleeding, it is important to reduce the amount of bleeding during and after lower segment cesarean section especially in patient complicated by placenta previa. Tranexamic acid is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of the lysine binding sites on plasminogen molecules. Also TXA may enhance the effectiveness of patient’s own hemostatic mechanism. In the current study a pilot prospective randomized interventional trial was carried out on 52 women clinically diagnosed with placenta previa undergoing cesarean section in the labor ward in Ain Shams University Maternity Hospital. The aim of this study is to determine the efficacy of using tranexamic acid preoperatively on decreasing intra- and post-operative blood loss after cesarean sections complicated with placenta previa by estimation of hemoglobin and hematocrit before and 24 hours after operation. A 52 pregnant female were included in this study and all were planned for cesarean section because of placenta previa. They were randomly divided in to two groups, study group (N=26) including women who received 1 gram of tranexamic acid diluted in 500 cc of ringer lactate intravenous during the attack of bleeding while the control group received 500 cc of ringer lactate. Both groups received their medication during the attack of bleeding in women with placenta previa undergoing cesarean section 20 minutes before making the skin incision, in addition to 30 IU of oxytocin after delivery of the baby. Both provider and researcher were double blinded.