Abstract
Objective: To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. Methods: A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. Results: Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group’s total blood loss (149.22 ± 54.74 ml) was significantly less than the control group (353.75 ± 115.56 ml) (p the control group (p the control group (p Conclusion: The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.
Highlights
Worldwide 15% of deliveries are done by cesarean [1]
This was a prospective double-blind randomized controlled clinical trial study conducted at Ain Shams University Maternity Hospital, Cairo, Egypt from January 2019 to October 2019. It is registered under NCT02604719 on clinicaltrials.gov. 64 women at 38 - 40 weeks of gestation at high risk for postpartum hemorrhage and planned for elective delivery by lower segment caesarean section were eligible for inclusion in the study
Six women were excluded from the study; 3 women with a history of venous thrombosis, 2 women had medical disorders and 1 woman had abnormal placentation. 64 women were included in the final analysis, divided randomly into two groups; 32 women in the study group and 32 women in the control group
Summary
Worldwide 15% of deliveries are done by cesarean [1]. cesarean delivery is planned to be a lifesaving procedure, diminishing both maternal and fetal morbidity and mortality [2], blood loss during cesarean is double that of vaginal delivery [3]. Its risk factors include previous PPH, multiple pregnancies, polyhydramnios, and macrosomia [4] Most of these could be avoided through the use of prophylactic uterotonics by timely and appropriate management [5]. Medications such as oxytocin, ergometrine, prostaglandin F2α, and misoprostol (prostaglandin E1) are commonly used to minimize intraoperative and postoperative blood loss during cesarean delivery [6] [7]. In addition to this enhancement of chemical hemostasis, a complementary biochemical hemostatic effect might be expected from the complementary use of prohemostatic drugs as tranexamic acid or ethamsylate [8]
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