Sublingual Misoprostol and Intravenous Tranexamic Acid for Reducing Blood Loss during Elective Cesarean Section

Abstract

. ABSTRACT Background: Obstetric blood loss is a significant cause of maternal mortality, and it is frequently underestimated and thus inadequately replaced. The most common major operation performed on women worldwide is a caesarean section. Cesarean section (C.S) is mainly linked to varying levels of blood loss. Aim of the Work: Evaluate the effects of intravenous Tranexamic acid (TXA) and sublingual Misoprostol on reducing bleeding during C.S. Materials and Methods: This was a prospective comparative study that was conducted at the obstetrics & gynecology department of Mansoura University Hospital and included one hundred patients with the following inclusion criteria: Elective CS, full-term birth (38-41 weeks), singleton pregnancy, and no medical disorders. Patients with severe medical and surgical conditions associated with pregnancy were excluded. Subjects included in the study were divided into two equal groups as follows: group A included 50 patients who received 400 µg sublingual misοprοѕtol, and Group B included 50 patients who received 1 g Tranexamic acid. Follow up of vital signs, vaginal blood loss, and uterine tone every 30 minutes for 2 hours, then every hour up to 24 h. blood loss was calculated from the suction apparatus that collects blood after delivery of the placenta to exclude parietal blood loss and amniotic fluid, in addition to the surgical towels and mats below patients. A complete blood count was done before and 2 hours post-operative to calculate the haemoglobin and hematocrit deficit. Results: Regarding the vital data, both systolic & diastolic blood pressure of Tranexamic acid were slightly lower than the misοprοѕtol group either after delivery of the placenta or 2 hrs post-operative, but this difference was not statistically significant. Also, the post-operative heart beats were higher in the Tranexamic acid group than in the misοprοѕtol group. The amount of sucked blood from Towels (Blood loss from placental delivery till end of operation) was higher in the Tranexamic Acid group (400.6 ± 37.8 ml) than misοprοѕtol group (389.1 ± 45.7 ml). Also, the weight of the disposable mat (Blood loss from the end of operation till 24 h post-operative) in the Tranexamic Acid group was heavier than in the misοprοѕtol group (641.3 ± 46.7 ml & 510.8 ± 58.8 ml respectively). The difference was statistically significant between both groups regarding the amount of sucked blood from Towels & the Weight of disposable mat ( P= 0.00 & 0.022 respectively). Conclusion : Sublingual 400 µg of Misoprostol before elective cesarean section is a safe, easily administered medication that is associated with decreasing the incidence of PPH without causing complications