2020, Vol. 2, Issue 2, Part B

Study Design: Randomized case control study

Study Setting: AlKarkh Maternity Hospital, Baghdad Iraq.

Methodology: A total of 110 term pregnant women presenting in to our obstetric unit during the period between May, 2019 and January, 2020 and who were offered elective cesarean section, were randomly assigned to either receiving intraoperative tranexamic acid 1 gram in 100 milliliter saline infusion or saline infusion. Demographic characteristics were collected for all participants. Ten cases (1 in the tranexamic and 9 in the control group) were excluded as there were associated extensions of uterine incision in order to reduce confounders. A comparison of the outcomes of the two groups was done, it included an intraoperative blood loss determinator, a postoperative blood loss determinator, and an overall loss risk assessment. The corresponding parameters were the intraoperative surgical soaked packs count, average reduction in packed red blood cell volume 24 hour postoperatively, occurrance of postpartum hemorrhage and the overall need to receive blood transfusion. In term of associated side effects of receiving tranexamic acid, we sought whether there was any significant change in the blood pressure as well as the incidence of developing fever. Exclusion criterias were the contraindication to receive tranexamic acid assessed by referral to internist physician specialist review.

Results: Confounding factors including patient’s age, parity and gestation length were taken into consideration and found to be similar between the two groups studied.

There was a significant difference between the postpartum decline of packed red blood cell volume (PCV) (pvalue 0.001), with mean postpartum PCV in tranexamic group 35.2% versus 33.3% in the saline infusion group. 21.9% of women in the control group had decline of PCV exceeding 10% of preoperative value, versus only 3.3% in studied group. We found that the number of cesareans where additional packs got required was significantly less in tranexamic group (15.3% vs.22%, p=0.001), no cases in the tranexamic group did receive a blood transfusion vs. 7.3% in the saline group (pvalue 0.03).Slightly higher incidence of hypotensive episodes in the tranexamic group (27.1% vs. 12.2%, pvalue 0.07).Fever was found to be more likely following cesarean in the control group (34.1% vs. 18.6%, pvalue 0.06).

Conclusion: The use of tranexamic infusion with inducton of anaesthesia at time of elective cesarean section is associated with less risk of intraoperative blood loss improving postoperative packed red blood cell volume decline significantly.