Comparison of intravenous tranexamic acid versus sublingual misoprostol in reducing blood loss in patients undergoing caesarean section-an analytical observational study

Authors

  • Deeksha Rao M. Department of Obstetrics and Gynaecology, Sri Devaraj URS Medical College, Kolar, Karnataka, India
  • Munikrishna M. Department of Obstetrics and Gynaecology, Sri Devaraj URS Medical College, Kolar, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230677

Keywords:

Haemorrhage, Uterotonics, CS, Postpartum, Anti-fibrinolytic agents

Abstract

Background: Preventing postpartum haemorrhage using uterotonics or other antifibrinolytic drugs is need of the hour among women undergoing caesarean section (CS). This study is to compare the effectiveness of intravenous Tranexamic acid versus sublingual misoprostol in reducing blood loss by assessing intraoperative and postoperative blood loss in patients undergoing CS.

Methods: Analytical observational study was conducted in department of obstetrics and gynaecology at sri Devaraj URS medical college, among 118 pregnant women admitted for CS. Study was conducted between January 2020 to June 2021. The sample was divided equally into intravenous tranexamic acid and sublingual misoprostol groups. Number of mops, pads soaked, suction volume excluding the amniotic fluid, preoperative and post-operative haemoglobin, any complication were recorded.

Results: The mean of mops counts in the misoprostol, TXA group were noted as 4.73±1.27, 3.2±1.45 respectively. Around 8.47% of the participants in the misoprostol group required uterotonics, whereas, 15.25% in the TXA group required uterotonics. The preoperative and postoperative haemoglobin in misoprostol group were identified as 11.67±1.37, 10.78±1.12 respectively, whereas it was identified as 11.76±1.43, 11.17±1.4 in TXA group. The common side effects identified in the misoprostol group was chills, vomiting and fever with 47.46%, 13.56% and 11.86% while, it was 11.86%, 5.08% and 3.39% in the TXA group.

Conclusions: Both intravenous tranexamic acid, sublingual misoprostol could be prescribed as standard therapy to significantly control blood loss and increase the quality of surgery with better outcomes. But the use of TXA proved slightly better as there were lesser side effects and significantly lesser blood loss in uncomplicated cases.

 

References

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Kirmeyer S et al. Births: final data for 2007. Natl vital Stat. 2010;58(24):1-85.

Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Fed Obstet Gynaecol. 2017;9(1):9-13.

Mirghafourvand M, Mohammad-Alizadeh S, Abbasalizadeh F, Shirdel M. The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage: A double-blind randomised controlled trial. Aust N Zeal J Obstet Gynaecol. 2015;55(1):53-58.

Quantin C, Benzenine E, Ferdynus C, Sediki M, Auverlot B, Abrahamowicz M et al. Advantages and limitations of using national administrative data on obstetric blood transfusions to estimate the frequency of obstetric hemorrhages. J Public Heal (United Kingdom). 2013;35(1):147-56.

Alam A, Choi S. Prophylactic Use of Tranexamic Acid for Postpartum Bleeding Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Transfus Med Rev. 2015;29(4):231-41.

McClure EM, Jones B, Rouse DJ, Griffin JB, Kamath-Rayne BD, Downs A et al. Tranexamic acid to reduce postpartum hemorrhage: A MANDATE systematic review and analyses of impact on maternal mortality. Am J Perinatol. 2015;32(5):469-74.

Bahadur A, Khoiwal K, Bhattacharya N, Chaturvedi J, Kumari R. The effect of intrauterine misoprostol on blood loss during caesarean section. J Obstet Gynaecol (Lahore). 2019;39(6):753-6.

Youssef AEA, Khalifa MA, Bahaa M, Abbas AM. Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial. Open J Obstet Gynecol. 2019;09(04):529-38.

Sahhaf, Abbasalizadeh S, Ghojazadeh M, Velayati A, Khandanloo R, Saleh P et al. Comparison effect of intravenous tranexamic acid and misoprostol for postpartum haemorrhage. Niger Med J. 2014;55(4):348.

Pakniat H, Chegini V, Shojaei A, Khezri MB, Ansari I. Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial. J Obstet Gynecol India. 2019;69(3):239-45.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 76: Postpartum Hemorrhage. Obstet Gynecol. 2006;108(4):1039-48.

IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. 2013.

Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention? A systematic review and meta-analysis. Med (United States). 2017;96(1):1-11.

Chaudhuri P, Mandi S, Mazumdar A. Rectally administrated misoprostol as an alternative to intravenous oxytocin infusion for preventing post-partum hemorrhage after cesarean delivery. J Obstet Gynaecol Res. 2014;40(9):2023-30.

Othman ER, Fayez MF, El Aal DEMA, El-Dine Mohamed HS, Abbas AM, Ali MK. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: A randomized clinical trial. Taiwan J Obstet Gynecol. 2016;55(6):791-5.

Tabatabaie SS, Alavi A, Bazaz M. Comparison of the effect of tranexamic acid and misoprostol on blood loss during and after cesarean section: A randomized clinical trial. Razavi Int J Med. 2021;9(1):e811.

Okonofua FE, Ogu RN, Akuse JT, Ujah IAO, Galadanci HS, Fabamwo AO. Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: Results of a multicenter trial. J Obstet Gynaecol Res. 2014;40(3):718-22.

Hua J, Chen G, Xing F, Scott M, Li Q. Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2013;120(5):531-40.

Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine P et al. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage. Obs Gynecol. 2015;126(1):155-62.

Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017;95(7):442-9.

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Published

2023-03-14

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Original Research Articles