Abstract
Objective: To evaluate the efficacy of tranexamic acid for prevention of postpartum haemorrhage among women undergoing cesarean section who were at high risk of postpartum hemorrhage. Materials and Method: This was a double blind randomized controlled trial conducted at the Alex Ekwueme Federal University Teaching Hospital Abakaliki from January 2016 to December 2017. One hundred and sixty-eight parturients at high risk of postpartum haemorrhage who underwent caesarean section were randomly assigned to receive either tranexamic acid or placebo prior to skin incision. Results: The result of the study showed that the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively). The incidence of primary post-partum hemorrhage (blood loss > 1000 ml) was significantly lower in the tranexamic acid group compared to placebo group (11.9% versus 50%, respectively, P-value < 0.0001). Conclusion: Intravenous tranexamic acid given prior to skin incision at caesarean section reduced the need for additional uterotonics and incidence of primary postpartum among high risk women.
Highlights
The result of the study showed that the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively)
The two studied groups were matched with no significant difference between the study and control groups regarding mean age, body mass index (BMI) and gestational age (Table 1), risk factors for postpartum haemorrhage and indications for caesarean section (Table 2 and Table 3)
There the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively, P-value < 0.0001) (Table 4)
Summary
The majority of maternal deaths and complications attributable to postpartum haemorrhage could be prevented or minimized with timely access to medications and emergency care [5]-[18]. The cases of mortality due to obstetric haemorrhage are mainly related to other causes of PPH [15]. Uterine atony was found only in 6.4% of cases of maternal death related to obstetric haemorrhage [16]. Other conditions such as abruption, placenta praevia, ruptured uterus, retained placenta, morbidly adherent placenta, vaginal and cervical trauma, inverted uterus, bleeding during and after caesarean section (CS) are the cause of the vast majority of maternal deaths [17] [18] [19] [20].
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