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Salud(i)Ciencia

Print version ISSN 1667-8682On-line version ISSN 1667-8990

Salud(i)Ciencia vol.23 no.3 Ciudad autonoma de Buenos Aires Dec. 2018

 

Authors' chronicles

Role of tranexamic acid in reducing blood loss during and after caesarean section

Papel del ácido tranexámico para la reducción de la pérdida de sangre durante la cesárea y después de esta

 

Simran Bhatia 1

1 Dr.d.y.patil Medical College Hospital And Research Centre., Pune, India

Simran Bhatia describes for SIIC his article published in Medical Journal of Dr. D.Y. Patil University 8(1):21-25, January 2015

 

 

Bijapur, India (special for SIIC)
Loss of blood during vaginal or operative delivery is always a matter of prime concern. Despite significant progress in obstetric care, 125 000 women die from obstetric hemorrhage annually in the world. Caesarean section rates have increased to as high as 25% to 30% in many areas of the world.

In spite of the various measures to prevent blood loss during and after caesarean section, postpartum hemorrhage (PPH) continues to be the most common complication seen in almost 20% of cases, leading to increased maternal morbidity and mortality.

Tranexamic acid (TXA) has been routinely used to reduce hemorrhage during and after many types of surgical procedures.

A prospective study was undertaken by the Department of Obstetrics and Gynaecology of Dr. D. Y. Patil Medical College, Hospital and Research Centre during 2011-2012 to evaluate the efficacy and safety of TXA in reducing blood loss after placental delivery following lower segment caesarean section (LSCS), and record any adverse effects following its administration. A total of 100 women who underwent LSCS between 23 and 28 years of age, height varying from 145-162 cm, body weight ranging between 50-60 kg at term between 37 to 41 weeks, either elective or as an emergency, were studied. These were divided into two groups of equal numbers. Study group received TXA while control group did not receive TXA. Same exclusion criterion defined both groups.

TXA 1 gram diluted in 10 ml of distilled water was given slowly intravenously over 10 minutes in study group, 20 minutes before making skin incision, whereas control group of 50 did not receive any TXA.

Outcomes studied were vital parameters, blood loss from time of placental delivery until 2 hours postpartum, hemoglobin level, liver and renal function tests in the immediate post-operative period.

Heart rate, respiratory rate and blood pressure were comparable in the two groups.

Significant difference in the quantity of the blood loss from time of placental delivery to 2 hours postpartum was noticed. There was also statistically significant difference in quantity of blood loss from end of LSCS to 2 hours postpartum. However, no significant difference in quantity of blood loss from time of placental delivery to end of LSCS was observed.

A randomized case controlled prospective study was conducted on 100 women undergoing LSCS. TXA significantly reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum, which was 86.5 ml in the study group versus 142.70 ml in control group (p < 0.001). Similar findings have been observed in the present study.

Ferrer et al. in his three randomized controlled trials involving 461 patients who underwent caesarean section delivery found that TXA use significantly reduced blood loss compared to those not receiving it.

A systemic review and cumulative meta-analysis of 129 trials totalling 10 488 patients carried out between 1972 and 2011 was done to estimate the effect of TXA on surgical bleeding. This analysis revealed that TXA reduced blood transfusion in surgical patients.

Mean drop in hemoglobin was 0.5 gm% (SD: 0.15 gm%) in study group with a mean of 0.9 gm% (SD: 0.14 gm%) in control group, which was statistically insignificant.

In our study, we observed significantly greater hemoglobin level of 12.57 ± 1.33 gm% in study group who received TXA, compared to 11.74 ± 1.14 gm% in control group (p = 0.002), which was statistically insignificant.

No side effects were observed in our study and it did not affect liver and renal functions.

There is a global commitment to the Millennium Development Goal (MDG) of reducing maternal deaths by three quarters by 2015, a commitment that requires a reduction of the maternal mortality ration by 5.5% each year. Because maternal hemorrhage accounts for over a quarter of deaths, an effective treatment for PPH would contribute importantly to MDG of reducing maternal mortality.

Our study is a small contribution towards the WOMAN Trial (World Maternal Antifibrinolytic Trial) which aims to determine the effect of early administration of TXA on mortality, hysterectomy and other morbidities (surgical interventions, blood transfusion, risk of non-fatal vascular events) in women with clinically diagnosed PPH. The use of health services and safety, especially thromboembolic effect on breastfed babies, will also be assessed. The trial will be large, pragmatic, randomized, double blind, placebo controlled trial among 15 000 women with a clinical diagnosis of PPH.

A small sample size and duration of study period are limitations of this study which is undertaken to draw attention to the need for undertaking multicentre randomized controlled trials to study its effect on thromboembolic events.

Conclusion: A safe dose of TXA plays an effective role in reducing blood loss during lower segment caesarean section, without causing complications. This drug can be used effectively in reducing maternal morbidity and mortality during LSCS. Although devoid of any side effects, its effect on thromboembolic events remains uncertain.

 

 

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