TRANEXAMIC ACID PLUS OXYTOCIN PROPHYLAXIS IN REDUCING BLOOD LOSS AND PREVENTING POSTPARTUM HEMORRHAGE DURING CESAREAN SECTION

Objective: To find the efficacy of prophylactic tranexamic acid and Oxytocin in preventing postpartum hemorrhage during cesarean section as compared to uterotonic alone. Materials and Methods: A randomized clinical trial that was single-center, double-blind placebo-controlled was conducted in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, between 1st July 2021 to 31st December 2021. A total of 280 patients undergoing cesarean section were randomized to group A receiving tranexamic acid and uterotonic (oxytocin) and control group B having placebo and uterotonic(oxytocin) within three minutes of delivery of the baby. Blood loss after the cesarean section was calculated from blood volume and pre and post-operative hematocrit. The main outcome of the study was to establish the efficacy of tranexamic acid in decreasing the number of women with calculated estimated blood loss> 1000 ml. Secondary outcomes included differences in mean calculated blood loss, peripartum change in hematocrit, and postoperative blood transfusion in both groups. Data was analyzed by statistical package for social sciences(SPSS) version 23.0. Mean and standard deviation were calculated for numerical data and percentages, and frequencies for categorical variables. To see the effects of modifiers, post stratified t-test was used. P-value <0.05 was considered statistically significant. Results: Both the groups were comparable for maternal age (28.4±4.5, 28.8±4.9) gestational age (37.71±1.61, 37.70±1.56), and parity (1.79±1.5, 2±1.6). Tranexamic acid significantly reduced the number of women with estimated calculated blood loss of > 1000 ml in group A to 10%(n=14) as compared to 18.6%(n=26) in group B (p-value<0.005). Secondary outcomes like mean calculated blood loss and postoperative blood transfusion were statistically insignificant between the two groups. Conclusion: Pregnant women who received prophylactic uterotonic agents and tranexamic acid treatment within three minutes of cesarean delivery, resulted in a lesser number of women with calculated estimated blood loss > 1000 ml than placebo. Key Words: Primary postpartum hemorrhage, Tranexamic acid, Cesarean section, Blood loss.