Comparative study of oxytocin versus tranexamic acid and ethamsylate in preventing primary postpartum hemorrhage in women undergoing lower-segment cesarean section

Abstract

Background: Worldwide, 21% of deliveries are by elective cesarean sections (C/S) as a procedure to reduce maternal and neonatal mortality and morbidity. Blood loss during C/Ss is more than vaginal delivery. Therefore, reducing blood loss during the C/Ss is essential and challenging for anesthesiologists and obstetricians. This study aimed to assess the efficacy of intravenous oxytocin versus tranexamic acid + ethamsylate (TXA + Eth) in reducing blood loss in pregnant women at high risk of primary PPH undergoing elective lower-segment cesarean section. Materials and Methods: A single-center, prospective, randomized, and double-blind study was started after obtaining institutional ethical approval. The study involved women undergoing elective C/Ss at full-term pregnancy at high risk for primary postpartum hemorrhage (PPH) at the SAMSRI between September 2021 and March 2022. The study participants received an infusion of either oxytocin 10 International Unit or TXA 1 g + Eth 250 mg before the skin incision. The primary outcome was the blood loss calculation, alongside hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into primary PPH and required blood transfusion. Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly reduced bleeding during and after cesarean section in pregnant women at high risk for PPH. In oxytocin and TXA + Eth groups, postoperative blood loss was (613.7 ± 123.7 and 406.2 ± 116.5) ml, respectively, P < 0.001. The duration of surgery in oxytocin and TXA + Eth groups were (48.5 ± 9.3) and (44.3 ± 9.8) minutes, respectively (P = 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups were 10.69% and 0.75%, respectively (P = 0.023). The PPH in the oxytocin and TXA + Eth groups were 2.30% and 0%, respectively (p < 0.017). Pre- and postoperative hemoglobin and hematocrit values at 24 h after cesarean section in the oxytocin (10.78 and 8.29) and (32.23 + 25.10) and TXA + Eth groups were (11.07 and 10.02) and (33.20 and 30.73), respectively (P < 0.001). Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss, and the demand for blood transfusion after cesarean section.