Department of Obstetrics and Gynaecology, JSS Medical College and Hospital, JSSAHER, Mysore, India. GRID: grid.414778.9. ISNI: 0000 0004 1765 9514 Department of Anaesthesiology, JSS Medical College and Hospital, JSSAHER, Mysore, India. GRID: grid.414778.9. ISNI: 0000 0004 1765 9514
Journal of obstetrics and gynaecology of India. 2020;70(6):479-484
Pregnant women undergoing elective or emergency lower segment caesarean section (n= 200).
Intervention
Tranexamic acid (10 mg/Kg) in 100 ml Normal Saline 10 mins prior to skin incision to along with routine care (n= 100).
Comparison
Routine care, as per institutional protocol (n= 100).
Outcome
There was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative haemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery.
Abstract
OBJECTIVES To determine the efficacy of tranexamic acid in decreasing blood loss in elective/emergency LSCS. MATERIALS AND METHODS A prospective randomised case control study was done in 200 pregnant women undergoing elective/emergency LSCS in the Department of Obstetrics and Gynaecology, at a tertiary care teaching hospital in Mysuru, from December 2018 to September 2019. Women in the age group of
18-35 years were included in the study. Those with anaemia (Hb < 10 gm%), hypertension in pregnancy, bleeding diathesis, GDM on insulin, polyhydramnios, oligohydramnios, cardiac and chronic liver disorders were excluded from the study. Two hundred women undergoing emergency/elective LSCS were divided into case (group 1) or control (group 2) groups using a computer-generated random number table. Tranexamic acid (10 mg/Kg) was given in 100 ml Normal Saline 10 mins prior to skin incision to women in the first group, along with routine care (10 Units of Oxytocin IM soon after extraction of the baby). Routine care, as per institutional protocol, was followed in the second group. The primary outcome was to estimate the intraoperative blood loss. Blood loss was measured by weighing pads, mops, drapes before and after surgery and blood in the suction container after surgery. Two separate suction catheters and containers were used, in order to minimise mixing of blood and amniotic fluid. Total blood loss was calculated as the difference in the weight of the pads, mops and drapes before and after surgery and the sum of the amount of blood in suction container. The difference between the pre-operative and post-operative haemoglobin and haematocrit was compared. The pre-operative, intra-operative and post-operative hemodynamics were also compared. RESULTS Statistical analysis was done using MS Excel and R-3.5.1 software. Unpaired and paired t test were used. In our study, there was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative hemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery. CONCLUSION Tranexamic acid can be safely used as a prophylactic agent to reduce bleeding during elective and emergency LSCS.
