Effect of Intravenous Tranexamic Acid Administration on Blood Loss during and after Caesarean Delivery: A Randomised Controlled Study

Abstract

Introduction: India remains a major contributor to maternal deaths in the world. Haemorrhage after delivery (both vaginal & caesarean) is the leading cause. To reduce the haemorrhage, oxytocics are routinely used. In heavy bleeding, blood transfusion may be required and in few cases obstetric hysterectomy may have to be done. Tranexamic Acid (TXA) injection has been shown to be very effective in reducing blood loss in various surgeries including Caesarean Section (CS). Aim: To know the efficacy of intravenous TXA administration in reducing blood loss during and 2 hours after caesarean delivery. Materials and Methods: This study was a randomised, placebo controlled, clinical study in which patients scheduled for CS in the District Hospital, Nadia were randomised into two groups, using a random number table list to receive either 1 gm (in 10 mL) of intravenous TXA dissolved in 20 mL of 5% dextrose solution (study group; n=50) or placebo, i.e., 30 mL of 5% dextrose solution (control group; n=50). Infusion was given 20 minutes before spinal anaesthesia. Categorical (number & percentage of patients) and continuous (Mean±Standard Deviation) variables were compared across the groups using the Chi-Square test for Independence of Attributes and unpaired t-test, respectively. Results: The mean intraoperative, postoperative and total blood loss were significantly lower in the study group (512.58, 65.06 & 577.64 mL, respectively) than the control group (731.68, 114.82 & 846.5 mL, respectively), p-value 35 units) oxytocin infusion. There was significant difference in pre and postoperative pallor (24 vs 37 patients in study & control group respectively, p-value- 0.008), pulse rate (mean difference 4.96/min in study group & 11.14/min in control group, p-<0.001), haemoglobin (mean difference 0.13 gm% in study & 1.28 gm% in control group, p-<0.001) level & packed cell volume (mean difference 1% in study group & 3.34% in control group, p-<0.001). Other vital parameters were not comparable. None of the babies required admission in Neonatal Intensive Care Unit (NICU). No sign of thrombosis was noted in any mother of either group. Incidence of postoperative nausea (15 and 12 patients in study & control groups, p -0.499), vomiting (10 and 9 patients in study & control groups, p=0.799) were insignificant. No cases of diarrhoea occurred in any group. Conclusion: Preoperative treatment with intravenous TXA significantly reduces blood loss related to caesarean delivery without any significant adverse effects to both mother and newborn.

Keywords

• antifibrinolytic
• caesarean section
• clinical trial
• pregnancy
• postpartum haemorrhage