Blood Loss In Cesarean Section Research Articles

Rectal misoprostol versus tranexamic acid in reducing intra &post operative blood loss in cesarean section

Rectal misoprostol versus tranexamic acid in reducing intra &post operative blood loss in cesarean section

Efficacy and safety of rectal misoprostol versus intravenous oxytocin on reducing blood loss in cesarean section: A PRISMA-compliant systematic review and meta-analysis of randomized clinical trials.

Blood loss is an inevitable complication and a major contributor to maternal morbidity and mortality at cesarean deliveries. We detected a potential preference regarding the efficacy and safety of rectal misoprostol over oxytocin as a uterotonic agent. We searched PubMed, Scopus, Web of Science, Cochrane, and other databases for the relevant trials from inception to September 2022. We included randomized clinical trials (RCTs) that compared rectal misoprostol versus intravenous oxytocin to control bleeding in women undergoing cesarean delivery. Our primary outcomes were the intra- and postoperative blood loss, and hemoglobin drop after delivery. Secondary outcomes included the need for blood transfusion, need for additional uterotonics, difference in operative time, as well as safety outcomes such as the incidence of shivering, pyrexia, nausea, and vomiting. Our search strategy revealed 1007 unique records, of them we retrieved full texts of 19 articles to check their adherence to our eligibility criteria. Seven RCTs with 1,090 participants were included. We found a significant reduction in postoperative blood loss [MD: -27.9; 95% confidence interval (CI): (-53.85, -2.10); p=0.03], and Hb drop after delivery [MD: -11; 95% CI: (-0.19, -0.03); p=0.01]. There is no significant difference regarding intraoperative blood loss, operative time, need for blood transfusion, or need for additional uterotonics. We could not find a significant difference between the two groups regarding safety outcomes, except for a higher shivering incidence in the misoprostol group [RR: 0.33; 95% CI; (0.16, 0.70); p=0.004]. We found a significant reduction in postoperative blood loss with a potentially favorable safety profile in women who administrated rectal misoprostol compared with oxytocin administration. Our findings recommend and prefer rectal misoprostol as a cheaper and effective uterotonic agent over oxytocin, which is expensive and requires an adequate cold chain for transportation and storage.

Design of a postpartum hemorrhage and transfusion risk calculator

BackgroundPostpartum hemorrhage is the major cause of maternal deaths due to childbirth and also responsible for maternal morbidity. ObjectivesIn this study we set out to look the incidence of postpartum hemorrhage in our population, to identify the most important risk factors for postpartum hemorrhage and thus develop a predictive risk calculator for postpartum hemorrhage and transfusion. Study designdata was taken from patients who presented vaginal delivery or cesarean section from January 1 to December 31, 2016, the variables taken into account as risk factors were as follows: Gestational age, history of chronic or gestational hypertension, preeclampsia, previous abortions, parity, previous cesarean section, placenta previa, labor time, and postpartum hemorrhage as the event of interest. An objective quantification was performed on a weight scale in grams for the estimation of bleeding, considering postpartum hemorrhage those with >500 ml in vaginal delivery and >1000 ml of blood loss in cesarean section. Subsequently, a predictive risk calculator was developed using the Naïve Bayes algorithm. ResultsA success rate of 58% was obtained in the identification of patients at high risk of hemorrhage, and 36% for transfusion, with a sensitivity of 50.7% and specificity of 64.06%, identifying as risk factors for postpartum hemorrhage gestational age between 35 and 40 weeks, hypertension and preeclampsia, previous cesarean section, duration of labor <1 h or more than 10 h, placenta previa and previous history of postpartum hemorrhage. ConclusionA postpartum hemorrhage risk calculator has been designed, which due to its improved accuracy after incorporation of data becomes a useful tool that will require a larger study population to improve its performance in clinical practice and more similar studies to validate it.

Efficacy of intravenous tranexamic acid in reducing blood loss during and after elective cesarean section

Background Tranexamic acid (TXA) is one of the prominent amino acid lysine synthetic derivatives having its antifibrinolytic effect through the reversible blockade of the lysine-binding sites on plasminogen molecules. It is regularly administered intravenously to treat and avoid bleeding, with good results. Objective This study was carried out to evaluate the effectiveness, safety, and complications of using TXA in elective cesarean section (CS). Patients and methods This was a prospective study that was conducted at Al-Zahraa University Hospital and El Sahel Teaching Hospital on 200 patients planned for elective CS: 100 patients were given 1 g/10 ml TXA (group A) diluted with 20 ml of 5% glucose, whereas another 100 patients received 30 ml of 5% glucose (group B) 10 min before CS. Following the delivery, patients in both groups received a 5 IU intravenous bolus of pre-prepared oxytocin followed by 30 IU oxytocin in 500-ml lactated Ringer's solution, infused at a rate of 125 ml/h. An antibiotic, 1 g cefazolin, was diluted in normal saline of 20 ml, and it was administered over a duration of 5 min. Estimated blood loss was measured by comparing the hematocrit values before and after the procedure. Results The study revealed a statistically significant decrease in hemoglobin level in group B (placebo group) compared with group A (TXA group), which indicates that there was a significant reduction in the amount of intraoperative and postoperative blood loss in CS in TXA group. Conclusion The use of TXA before CS shows positive effects and can be used as a prophylaxis against postpartum hemorrhage, as revealed by the findings of this study.

Efficacy of Tranexamic Acid in Reducing Blood Loss in Cesarean Section: A Comparative Study.

Introduction: Obstetric hemorrhage is one of the major causes of maternal morbidity and mortality. Blood loss during cesarean section is almost twice than that in vaginal delivery. The aim of this study was to evaluate the efficacy of tranexamic acid to reduce blood loss in cesarean section and its side effects. Methods: A comparative study was done in 100 women undergoing cesarean section between December 2015 to January 2017. The study group of 50 women received one gram intravenous tranexamic acid and the control group of 50 women did not receive tranexamic acid. Primary outcome measure was blood loss during cesarean section. Secondary outcome measures were drop in post-operative hemoglobin and hematocrit, change in pulse rate and blood pressure, need of additional uterotonics, auxiliary procedures to stop bleeding, blood transfusion rate and maternal and neonatal side effects of the drug. Results: Mean intraoperative blood loss in the study group was 443.62± 86.73ml; and in control group, 667.40±131.01ml (p&lt;0.001). Mean postoperative drop in hemoglobin (g/dl) in the two groups were 0.82±0.27 and 1.86±0.64 respectively (p&lt;0.001). Mean postoperative drop in hematocrit in the two groups were 2.60±0.91 and 5.49±1.97 respectively (p&lt;0.001). Fourteen patients in the control group required additional uterotonics while none in the study group (p&lt;0.001). There was no significant difference in the transfusion requirement (p=0.079). None of the mothers and the newborns had major side effects of drug. Conclusion: Tranexamic acid is a safe and effective drug to reduce blood loss in cesarean section.

The Effect of General and Spinal Anesthesia on Maternal Blood Loss in Elective Cesarean Section: a prospective Study

Background: This study aims to compare between general and spinal anesthesia regarding to the amount of maternal blood loss in cesarean section. Methods: This is a randomized controlled study conducted at Bab El Shaaria Hospital to compare maternal blood loss by general and spinal anesthesia. Results: The results showed that the group which had a cesarean section under spinal anesthesia has a statistically significant 2nd day postoperative higher level of hemoglobin (P< 0.001), when compared with general anesthesia, with a mean difference of 0.660g/dL and also a statistically significant 3rd day postoperative hematocrit percentage higher with the spinal anesthesia group with a mean difference of 1.507% (P= 0.002). Conclusion: The spinal anesthesia showed definite advantages over general anesthesia; being higher postoperative hemoglobin level and hematocrit value, less intraoperative blood loss, less need for blood transfusion, less postoperative pain and need for postoperative analgesia, and earlier ambulation. In addition; mothers were faster in starting breast feeding their babies

The Effect of General and Spinal Anesthesia on Maternal Blood Loss in Elective Cesarean Section: a prospective Study

Background: This study aims to compare between general and spinal anesthesia regarding to the amount of maternal blood loss in cesarean section. Methods: This is a randomized controlled study conducted at Bab El Shaaria Hospital to compare maternal blood loss by general and spinal anesthesia. Results: The results showed that the group which had a cesarean section under spinal anesthesia has a statistically significant 2nd day postoperative higher level of hemoglobin (P< 0.001), when compared with general anesthesia, with a mean difference of 0.660g/dL and also a statistically significant 3rd day postoperative hematocrit percentage higher with the spinal anesthesia group with a mean difference of 1.507% (P= 0.002). Conclusion: The spinal anesthesia showed definite advantages over general anesthesia; being higher postoperative hemoglobin level and hematocrit value, less intraoperative blood loss, less need for blood transfusion, less postoperative pain and need for postoperative analgesia, and earlier ambulation. In addition; mothers were faster in starting breast feeding their babies

Impact of general versus spinal anesthesia on maternal blood loss in cesarean section

Objective The aim of the study was to know which type of anesthesia, general or spinal, causes less amount of blood loss in elective cesarean section. Study design This was a randomized controlled trial conducted in Ain Shams University Maternity Hospital on 155 women. Seventy-seven women were allocated (after computer-generated randomization) to group G (general anesthesia), and 78 women to group S (spinal anesthesia). All patients underwent elective lower segment cesarean section following the same operative steps and by the same surgeon and their anesthesia, whether general or spinal, was standardized. Amount of intraoperative blood loss was estimated by the acute normovolemic hemodilution technique. Results On using hemoglobin level changes to estimate blood loss, it was seen that group S had significantly less blood loss than group G with a difference of 152.760 ml (P=0.003). On using hematocrit values, it was seen that group S had statistically significant less blood loss than group G, with a difference of 174.2 ml (P=0.001). Headache attacks were higher in group S (29.49%) than in group G (12.99%) (P=0.010). Group S started breast feeding 54.3 min earlier than group G (P=0.013). Group S started postoperative ambulation 69.36 min earlier than group G (P=0.014). Group G requested analgesia 17.6 min earlier than group S (P=0.035). No statistically significant differences were observed between the two groups with respect to postoperative pulse, blood pressure, urinary output, and fainting attacks. Conclusion Spinal anesthesia shows definite advantages over general anesthesia in terms of higher postoperative hemoglobin and hematocrit values, less intraoperative blood loss, less postoperative pain, less need for analgesia, earlier ambulation, and faster initiation of breast feeding.

Effect of expansion technique of uterine incision on maternal blood loss in cesarean section

The purpose of this study was to determine whether the method used to expand the uterine incision (sharp vs. blunt) for cesarean section (CS) affects maternal blood loss. A prospective study conducted on 200 nulliparous who underwent lower segment transverse CS divided into two groups. One hundred women were assigned to have blunt expansion of the uterine incision by fingers of the surgeon, and 100 women to have sharp expansion using bandage scissors. Finally, a comparison of two groups was made regarding blood loss, change in hematocrit, uterine tears and blood transfusion. P < 0.05 was considered significant. Maternal blood loss and postoperative hematocrit drop were significantly higher in sharp group (375 ± 95 cm³ in blunt vs. 443 ± 86 in sharp, P = 0.001 and 2.4 ± 2.6 in blunt vs. 4.1 ± 2.6 in sharp, P = 0.001, respectively). There was no significant difference in the extension of uterine incision. Our findings support that blunt expansion of uterine incision during lower segment cesarean is safer and easier than sharp expansion.

Tourniquet technique prevents profuse blood loss in placenta accreta cesarean section

Profuse bleeding in placenta accreta is life-threatening even under well-prepared cesarean sections. We used a tourniquet technique to temporally shut off blood flow through the uterine and ovarian vessels at the level of the uterine cervix. The tourniquet consisted of manual compression followed by a rubber tube. Total blood loss in cesarean section and hysterectomy in the two cases in which we applied this technique was significantly reduced compared with that in the two cases without it. This technique not only prevented massive bleeding from the accreted placentation, but also allowed physicians time to consider the necessity of subsequent hysterectomy.