Effect of Tranexamic Acid on Blood Loss in Elective Cesarean Delivery

Abstract

Background: tranexamic acid as an agent given before surgical procedures reduces the blood transfusion risk, mean volume lost, and the requirement for reintervention due to bleeding issues, without raising thrombotic risks. Aim: to evaluate Tranexamic acid agent infusion as regards its efficacy in blood volume loss reduction in practice of elective lower segment cesarean section delivery. Patients and Methods: A double blinded, randomized, controlled research clinical trial. All study subjects have been recruited from the cases scheduled for elective cesarean delivery in the labor ward of Mokattam Insurance Hospital. The study subjects were totally 200 cases allocated in by randomization into 2 research groups. The study research group have been composed of 100 cases that were administered a mixture of tranexamic acid 25mg/kg in 200 ml of normal saline by intravenous drip for 20 minutes before incision, while the control research group contained 100 cases administered a volume of normal saline in accordance to patient’s weight (25 mg/kg) by intravenous drip for 20 minutes before time of incision. Results: Blood loss volume was statistically significantly lower among Tranexamic research group than among placebo research group (p value <0.001). Postoperative hematocrit was statistically significantly higher among Tranexamic research group than among placebo research group (p value =0.020). Hematocrit reduction was statistically significantly lower among Tranexamic research group than among placebo research group (p value <0.001). PPH and blood transfusion were statistically significantly less frequent among Tranexamic research group (p values=0.010, 0.005 consecutively). Conclusions and Recommendation: The administration of tranexamic acid before starting a cesarean section is valuable as a prophylaxis against intra-operative and post-partum bleeding issues. Future research studies are required to consider various variables such as racial and ethnic differences and consider various clinical case scenarios e.g. previous cesarean delivery and categorization of more possible critical indications of cesarean such as second stage cesarean, emergency cesarean section and time interval of decision to incision as those variables could influence blood volume loss indices.