Blood Loss In Elective Surgery Research Articles

Prophylactic use of Tranexamic Acid during Caesarean Section in Preventing Postpartum haemorrhage– a Prospective Randomised Double Blind Placebo Controlled Study

Background: Postpartum haemorrhage (PPH) is a major cause of maternal mortality,accounting for one-quarter of all maternal deaths worldwide. Tranexamic acid (TXA), anantifibrinolytic agent, has therefore been investigated as a potentially useful complement toprevention and treatment of PPH. It has been proved to reduce blood loss in elective surgery,bleeding in trauma patients, and menstrual blood loss.
 Aims: To evaluate the effectiveness of TXA in reducing blood loss given just immediatelyafter delivery of baby in women undergoing cesarean section.
 Methods: This was a prospective, randomized, double blind, placebo controlled studyconducted in the Department of Gynaecology and Obstetrics unit of IBN SINA Medical CollegeDhaka, Bangladesh from June 2016 to May 2017. Participants were randomly assigned toTXA group or group A (n=60) and placebo group or group B (n=60). Randomization wasdone by residents using computer generated random numbers. Group A received 1 gram(10ml) of intravenous bolus dose of TXA just after delivery of the baby, Group B received 10ml of sterile distilled water for injection intravenously at the same time. Statistical analysishas been done by SPSS.
 Results: The subjective characteristics in the two groups were similar with respect to theirage, BMI, gestational age and gravidity. The duration of surgery was 40-50 minutes. Therewas no statistically significant difference in the heart rates (p>0.05) and blood pressuresbetween the two groups, after 2 hours of delivery. Blood losses from both placental deliveriesto the end of cesarean section and from end of CS to 2 hours postpartum were significantlylower in the study group (p<0.05). Change in hemoglobin concentration in study group wasalso significantly less than in the control group. Total amount of oxytocin required wassignificantly less in TXA group (p<0.05) also the number of women requiring other oxytocics(inj. Methyl ergometrine, inj carboprost and tab misoprostol per rectally) was significantlyless in TXA group (p< 0.05). The amount of intra-operative fluid required were significantlyless in TXA group (p<0.005); however post – operative fluid requirement and minor sideeffects in the form of nausea and vomiting were similar in both the groups.
 Conclusion: Tranexamic acid can effectively reduce blood loss in patients undergoing LSCSand its use was not associated with any side effects and or complications like thrombosis.The adoption of WHO guidelines for using uterotonic agents and prophylactically administeringTXA may significantly reduce the number of PPH incidents.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 125-130

Tranexamic Acid for the Prevention and Treatment of Postpartum Hemorrhage

(Br J Anaesth. 2015;114:576–587) Postpartum hemorrhage (PPH) is a major cause of maternal mortality, accounting for one-quarter of all maternal deaths worldwide. Uterotonics after birth are the only intervention that has been shown to be effective for PPH prevention. Tranexamic acid (TXA), an antifibrinolytic agent, has therefore been investigated as a potentially useful complement to this for both prevention and treatment because its hypothesized mechanism of action in PPH supplements that of uterotonics and because it has been proven to reduce blood loss in elective surgery, bleeding in trauma patients, and menstrual blood loss. This review covers evidence from randomized controlled trials (RCTs) for PPH prevention after cesarean (n1/410) and vaginal (n1/42) deliveries and for PPH treatment after vaginal delivery (n1/41). It discusses TXA efficacy and side effects overall and in relation to the various doses studied for both indications.

Study protocol. TRAAP - TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery: a multicenter randomized, double-blind, placebo-controlled trial.

BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal mortality, accounting for one quarter of all maternal deaths worldwide. Estimates of its incidence in the literature vary widely, from 3 % to 15 % of deliveries. Uterotonics after birth are the only intervention that has been shown to be effective in preventing PPH. Tranexamic acid (TXA), an antifibrinolytic agent, has been investigated as a potentially useful complement to uterotonics for prevention because it has been proved to reduce blood loss in elective surgery, bleeding in trauma patients, and menstrual blood loss. Randomized controlled trials for PPH prevention after cesarean (n = 10) and vaginal (n = 2) deliveries show that women who received TXA had significantly less postpartum blood loss without any increase in their rate of severe adverse effects. However, the quality of these trials was poor and they were not designed to test the effect of TXA on the reduction of PPH incidence. Large, adequately powered, multicenter randomized controlled trials are required before the widespread use of TXA to prevent PPH can be recommended.Methods and designA multicenter, double-blind, randomized controlled trial will be performed. It will involve 4000 women in labor for a planned vaginal singleton delivery, at a term ≥ 35 weeks. Treatment (either TXA 1 g or placebo) will be administered intravenously just after birth. Prophylactic oxytocin will be administered to all women. The primary outcome will be the incidence of PPH, defined by blood loss ≥500 mL, measured with a graduated collector bag. This study will have 80 % power to show a 30 % reduction in the incidence of PPH, from 10.0 % to 7.0 %.DiscussionIn addition to prophylactic uterotonic administration, a complementary component of the management of third stage of labor acting on the coagulation process may be useful in preventing PPH. TXA is a promising candidate drug, inexpensive, easy to administer, and simple to add to the routine management of deliveries in hospitals. This large, adequately powered, multicenter, randomized placebo-controlled trial seeks to determine if the risk-benefit ratio favors the routine use of TXA after delivery to prevent PPH.Trial registrationClinicalTrials.gov NCT02302456 (November 17, 2014)

Novel System for Rapid Assessment of Blood Loss in Elective Surgery and Cesarean Delivery

INTRODUCTION: Visual and gravimetric methods of estimating blood loss are severely limited by human error and the presence of large volumes of amniotic fluid, irrigation, or both. The study goal was to assess accuracy of a novel system for intraoperative monitoring of hemoglobin (Hb) loss. METHODS: After institutional review board approval, 50 patients undergoing elective surgery or cesarean delivery contributed laparotomy sponges intraoperatively. The iPad-based Triton system was used to measure Hb loss (g) and blood loss (mL) by scanning sponges exiting the surgical field. Hemoglobin loss measured by the device was compared with a rinsing (reference) method using linear regression and Bland-Altman analysis. The device's measure of estimated blood loss was compared with the gravimetric method (weighing sponges) and with health care providers' visual estimates. RESULTS: A strong positive linear correlation was observed between the device's measures and the reference method (r=0.91, P<.001). Bland-Altman analysis revealed a bias of 3.7 g Hb and narrow limits of agreement (−15.3 to 22.7 g Hb) between the two measures. Gravimetric method demonstrated a positive linear correlation (r=0.87, P<.001) with the reference method, yet overestimated mean estimated blood loss by 422 mL per patient (667 compared with 245 mL, P<.001). Visual estimation was weakly correlated (r=0.30, P<.05) with the reference method. CONCLUSION: This novel device may enhance the ability to rapidly and accurately quantitate ongoing bleeding and may enable health care providers to better manage fluid and blood product replacement in the setting of obstetric hemorrhage.

Case Scenario: Management of Trauma-induced Coagulopathy in a Severe Blunt Trauma Patient

Case Scenario: Management of Trauma-induced Coagulopathy in a Severe Blunt Trauma Patient

Preoperative fibrin monomer measurement allows risk stratification for high intraoperative blood loss in elective surgery

We recently demonstrated that patients with increased blood loss due to intraoperative coagulopathy show a persistent pre-, intra- and postoperative increase in fibrin monomer concentration. We thus tested the hypothesis that preoperative fibrin monomer concentrations can be used as a risk indicator for intraoperative blood loss in a study designed for diagnostic test evaluation in 168 patients admitted to the surgical service of our hospital. Intraoperative blood loss increased with preoperative fibrin monomer concentration (median blood loss of 50, 100, 200 and 400 ml in preoperative fibrin monomer quartile groups 1 to 4, p<0.001, ANOVA on ranks; interquartile comparisons p < 0.05 (4/6), Mann Whitney Rank Sum test). In contrast, intraoperative blood loss was unrelated to preoperative values of prothrombin time, activated partial thromboplastin time and platelet count. By multivariate (logistic regression) analysis, only fibrin monomer remained a significant predictor of intraoperative blood loss > 500 ml when age, gender, BMI, fibrin monomer and the different types of surgical procedures (tumor surgery, vascular surgery, cholecystectomy, gastric banding, varicous vein surgery and hernia repair) were included as independent variables. Most importantly, accuracy evaluation showed that preoperative fibrin monomer concentration < 3 microg/l excluded intraoperative blood loss > 500 ml with 92% sensitivity and 95% negative predictive value. These results support our hypothesis that preoperative fibrin monomer concentrations are related to intraoperative blood loss in elective surgery. Fibrin monomer should be further investigated for it's potential to serve as a routine tool for preoperative risk stratification of intraoperative bleeding.