Efficacy of Prophylactic Policy-Driven Tranexamic Acid Administration during Cesarean Delivery in a Rural Healthcare Setting.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Southern Medical Journal Pub Date : 2025-03-01 DOI:10.14423/SMJ.0000000000001796

Manuel C Vallejo, Anna L Zukowski, Jamie M Long, Christa L Lilly, Linda S Nield, Mark I Zakowski

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引用次数: 0

Abstract

Objectives: Postpartum hemorrhage (PPH) is a major contributor to maternal mortality worldwide and is a leading cause of pregnancy-related mortality in the United States. The American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, and the World Health Organization advocate for the early use of tranexamic acid (TXA) in the prevention of PPH. The purpose of this study was to determine the efficacy and patient characteristics of the use of prophylactic TXA administration during cesarean delivery (CD) as part of a newly instituted policy to reduce blood loss and PPH rates in a tertiary care regional rural and underserved maternal care center.

Methods: An electronic quality assurance chart review from February 2020 through October 2021 of more than 2705 patients was conducted, comparing two groups after implementation of a TXA protocol for all CDs. In total, four CD groups were analyzed (control group without TXA before policy, PPH group without TXA before policy, TXA control group after policy, and PPH group with TXA after policy).

Results: PPH rates decreased with TXA use (9.7% vs 1.5%). TXA use was more likely to be given to patients with one or more of the following characteristics: commercial insurance, self-identified Asian race, admission from a doctor's office, urgent CD delivery, fetal distress, abruptio placenta/placenta previa, and extended hospital length of stay with increased hospitalization cost. Subset analysis of 720 patients revealed decreased blood loss (896.4 ± 521.0 mL vs 771.1 ± 405.6 mL, P = 0.0004) and fewer blood transfusions with TXA use (6.7% vs 1.1%, P = 0.0001).

Conclusions: Prophylactic policy-driven TXA administration during CD protocol-driven TXA administration decreases PPH.

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农村卫生保健机构剖宫产预防政策驱动的氨甲环酸应用效果。

目的：产后出血（PPH）是全球孕产妇死亡的主要原因，也是美国妊娠相关死亡的主要原因。美国妇产科医师学会、英国皇家妇产科医师学会和世界卫生组织都提倡尽早使用氨甲环酸（TXA）来预防PPH。本研究的目的是确定在剖宫产（CD）中使用预防性TXA的疗效和患者特征，作为新制定政策的一部分，以减少三级保健地区农村和服务不足的孕产妇保健中心的失血和PPH率。方法：从2020年2月到2021年10月，对2705多名患者进行了电子质量保证图回顾，比较两组在对所有cd实施TXA方案后的情况。总共分析了四组CD（治疗前不含TXA的对照组、治疗前不含TXA的PPH组、治疗后TXA的对照组和治疗后含TXA的PPH组）。结果：PPH率随着TXA的使用而降低（9.7% vs 1.5%）。具有以下一种或多种特征的患者更有可能使用TXA：商业保险、自我认定的亚洲种族、从医生办公室入院、紧急CD分娩、胎儿窘迫、胎盘早剥/前置胎盘、住院时间延长和住院费用增加。720例患者的亚群分析显示，失血量减少（896.4±521.0 mL vs 771.1±405.6 mL, P = 0.0004），使用TXA后输血量减少（6.7% vs 1.1%, P = 0.0001）。结论：在CD方案驱动的TXA给药过程中，预防性政策驱动的TXA给药可降低PPH。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.