Tranexamic Acid plus Oxytocin Versus Oxytocin only in Reducing Blood loss after Cesarean Section. A Double Blinded Randomized Controlled Trial

Document Type : Original Article

Authors

1 Lecturer in Obstetrics and Gynecology – Faculty of Medicine – Ainshams university

2 Professor of Obstetrics and Gynecology – Faculty of Medicine – Ainshams university – Egypt

3 M.B.B.Ch, Resident of Obstetrics and Gynecology – Dametta specialized hospital – Ministry of health - Egypt

4 Assistant Professor of Obstetrics and Gynecology – Faculty of Medicine – Ainshams university – Egypt

Abstract

Objective: to assess the efficacy of tranexamic acid in re-ducing blood loss after cesarean section.
Patients and methods: This was a double blinded ran-domized controlled trial. One hundred and thirty patients admitted for elective cesarean section were randomized into two groups to receive either tranexamic acid plus oxy-tocin (group T) or oxytocin only (group A) after obtaining informed consent. The primary outcome of the study was the intraoperative blood loss. Other measures of outcome were the postoperative blood loss, the need for additional uterotonics, postopertative hemoglobin and hematocrit lev-els, need for blood transfusion and any side effects related to tranexamic acid.  
Results: tranexamic acid significantly reduced intraoper-ative blood loss after CS when combined with oxytocin; 246.5 ± 103.8ml in the tranexamic group versus 525.4 ± 99.4 ml in the oxytocin only group (P=<0.001). Postpartum blood loss was also reduced significantly in the tranexamic acid group; 77.7 ± 11.6 ml in the tranexamic acid group ver-sus 103.3 ± 11.3ml in the oxytocin only group (P=<0.001). Hb 24hrs after cesarean section was significantly greater in the tranexamic group; 11.3±1.0 g/dl versus 10.7±0.9 g/dl in the oxytocin only group (p=0.001). The need for additional uterotonics was significantly reduced among the tranexamic group; 3(4.6%) versus the oxytocin only group; 12(18.5%) with p value = 0.013. Operative time was significantly short-er in the tranexamic group; 65.8±13.0 min versus the oxyto-cin only group; 79.1±16.3min. No significant difference was found between the two groups regarding the need for blood transfusion and there was no reported neonatal side effects. 
Conclusion: tranexamic acid significantly reduced intraop-erative and postoperative blood loss after cesarean section and it can be safely used for prophylaxis against postpartum hemorrhage after cesarean section in low risk patients.

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