Efficacy of Intravenous Tranexamic acid in Reducing Blood Loss During and After Elective Caesarean Section

Abstract

stetric hemorrhage is the leading cause of maternal morbidity and mortality.Caesarean section (CS) rates have increased to as high as 25 to 30 % in many areas of the world. Delivery by CS can cause more complications than normal vaginal delivery and one of the most common complications is primary or secondary postpartum hemorrhage. It leads to increased maternal mortality and morbidity. Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality, especially in developing countries. 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 caesareansection (LSCS). 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. Tranexamic acid has been routinely used for many years to reduce hemorrhage during and after surgical procedures, such as coronary artery bypass, scoliosis surgery and knee arthroplasty. It has been shown to be very useful for reducing blood loss and blood transfusion. There are some reports on the use of tranexamic acid in prevention of blood loss in many gynecologic diseases such as menorrhagia and also CS. The aim of this study is to determine the efficacy of using tranexamic acid preoperatively on decreasing intra- and post-operative blood loss after elective Caesarean sections by estimation ofhemoglobin and hematocrit before and24hours after operation The current study was a randomized case controlled double blinded clinical trial conducted in Ain shams maternity hospital, 100 pregnant female were included in this study and all were planned for elective caesarean section. They were randomly divided in to two groups, Study group (N=50) including women who received 1 gram of Tranexamic acid intravenous 10 minutes before the skin incision, in addition to 10 IU of oxytocin after delivery of the baby. And control group (N=50) including women who received placebo in the form of 10 ml of 5% glucose intravenously before skin incision. Both provider and researcher were double blinded.