Efficacy of tranexamic acid in reducing blood loss, blood and blood products requirements in Cesarian sections for patients with placenta accreta

Tamer Hamed Ibrahim

doi:10.1186/s42077-019-0051-9

Abstract

BackgroundPlacenta accreta is an obstetric emergency and the main cause of maternal morbidity and mortality due to the associated bleeding and coagulopathy. Tranexamic acid has been widely used to decrease blood loss in trauma patients and patients with postpartum hemorrhage. We aimed at studying the effect of tranexamic acid in reducing blood loss and blood transfusion in patients with placenta accreta.MethodsIn a double-blinded randomized controlled study, 46 patients were recruited and divided into two groups, Group A is the tranexamic group where patients received 10 mg/kg tranexamic acid after cord clamping and continued on tranexamic infusion 10 mg/kg/h till the end of the surgery. Group B is the placebo where patients received normal saline instead. Primary outcome was the amount of intraoperative blood loss, and other outcomes included the number of blood and blood products transfused intraoperative and in the first 24 h postoperative, the immediate postoperative Hb level, platelet count, and coagulation profile. Data were collected, coded, tabulated, and then analyzed using Minitab® 16.1.0 statistics software package. Variables were presented as mean and standard deviation and analyzed using unpaired t test. Any difference with p value < 0.05 was considered statistically significant.ResultsAmount of intraoperative blood loss was significantly less in the tranexamic group 2232 ± 1204 ml compared to the placebo group 3405 ± 1193 ml (p value 0.002), and patients in the tranexamic group received less units of packed red blood cells, fresh frozen plasma, and platelets compared to those in the placebo group (4.2 ± 1.9 vs 6.1 ± 2.2 with p value 0.003, 3.4 ± 1.3 vs 4.2 ± 1.2 with P value 0.036 and 4.8 ± 2.1 vs 6.2 ± 2.4 with p value 0.041, respectively). There was no statistically significant difference in the first postoperative Hb level, platelet count, and coagulation profile between the two groups; however, the amount of blood and products transfused in the first 24 h postoperative were significantly less in the tranexamic groupConclusionTranexamic acid infusion was effective in reducing intraoperative blood loss and intraoperative and postoperative blood and blood products’ transfusion.

Highlights

Placenta accreta (PA) is the clinical condition of abnormal adherence of the entire or a part of the placenta to the uterine wall
Patients were excluded if they were admitted for emergency Cesarean section, admitted with bleeding, known to have coagulation disorders, with preoperative anemia ( defined as hemoglobin (HB) less than 8 gm/dl), thrombocytopenia, or any other medical diseases with pregnancy as pre-eclampsia or gestational diabetes, and patients were excluded if hysterectomy was performed
Between September 2016 and November 2018, 46 patients were recruited to the study and were divided into two groups as previously mentioned, 3 patients were excluded (2 from the Tranexamic acid (TXA) group and 1 from the placebo group) for whom hysterectomies were performed to control the bleeding, and those patients were replaced by another patients

Summary

Introduction

Placenta accreta (PA) is the clinical condition of abnormal adherence of the entire or a part of the placenta to the uterine wall. There is an increase in the uterine artery blood flow from 100 to 350 ml/min in normal pregnancy (Thaler et al 1990) which is further increased in patients with PA, as in these patients uterine blood vessels are larger in diameter with increased blood flow compared to normal pregnancy, but have less muscular tissue and thin elastic layer [3]. As a result, they become a source of uncontrolled hemorrhage when torn during delivery due to their inability to undergo vasospasm (Khong and Robertson 1987). We aimed at studying the effect of tranexamic acid in reducing blood loss and blood transfusion in patients with placenta accreta

Methods

Results

Conclusion