Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study

Abstract

ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.