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Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Tranexamic acid is a synthetic derivative of amino acid lysine that exerts its antifibrinolytic effect through an irreversible blockade of lysine binding site on plasminogen molecule. Tranexamic acid has been found to be very useful in reducing blood loss and incidence of blood transfusion during cesarean section and in varieties of others surgeries.
Objective: To study the prophylactic effect of intravenous tranexamic acid in reducing perioperative blood loss during elective caesarean section.
Methods: A randomized case controlled prospective study was conducted on 160 women undergoing lower segment caesarean section over a period of 15 months (25- 12-2020 to 25-3-2022). 80 of them were given intravenous tranexamic acid 20 min before skin incision and were compared with 80 others to whom tranexamic acid was not given. Blood loss was measured from placental delivery to end of caesarean section and from end of caesarean section to 2 hr. postpartum. Vital signs 2 hr. postpartum and APGAR score at 5 min were studied in both the groups. Further assessment of blood loss was done after 48 hr postpartum hemoglobin estimation.
Results: Tranexamic acid significantly reduces the quantity of blood loss from placental delivery to end of caesarean section: The blood loss in case groups who received tranexamic acid was found to be 310.75 ± 68.41 mL versus control group who did not receive tranexamic acid was 419.25 ± 158.89 mL, (p<0.0001). It also reduces quantity of blood loss from end of caesarean section to 2hr post-partum: 47.55 ± 12.29 mL in case group versus 83.75 ± 24.41mL in control group (P<0.0001).
Conclusion: Prophylactic use of intravenous tranexamic acid significantly reduced the amount of blood loss in perioperative period during elective caesarean section. It also decreased the need of blood transfusion and its use was not associated with any adverse effects on neonates.
Keywords: Tranexamic Acid, postpartum hemorrhage, Elective caesarean section.