Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section
Faheem, A., Gomaa, M., Alfakharany, R., Taha, A. (2024). Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section. EKB Journal Management System, 5(4), 87-99. doi: 10.21608/ejmr.2024.241755.1480
Ashrf Samir Faheem; Mohamed Ragab Gomaa; Reham S. Alfakharany; Ahmed A. Taha. "Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section". EKB Journal Management System, 5, 4, 2024, 87-99. doi: 10.21608/ejmr.2024.241755.1480
Faheem, A., Gomaa, M., Alfakharany, R., Taha, A. (2024). 'Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section', EKB Journal Management System, 5(4), pp. 87-99. doi: 10.21608/ejmr.2024.241755.1480
Faheem, A., Gomaa, M., Alfakharany, R., Taha, A. Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section. EKB Journal Management System, 2024; 5(4): 87-99. doi: 10.21608/ejmr.2024.241755.1480

Rectal misoprostol versus tranexamic acid for reducing intra &post-operative blood loss in cesarean section

Egyptian Journal of Medical Research
Volume 5, Issue 4, October 2024, Pages 87-99    PDF (495.84 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2024.241755.1480
Authors
Ashrf Samir Faheem1; Mohamed Ragab Gomaa* 1; Reham S. Alfakharany2; Ahmed A. Taha3
1Obstetrics and Gynecology department, Faculty of Medicine, Beni-Suef University, Egypt
2Physiology Department, Faculty of Medicine, Beni-Suef University, Beni-suef, Egypt
3Obstetrics and Gynecology department, Faculty of Medicine, Beni-suef University, Egypt
Abstract
Objective: Aim: To assess the impact of intravenous tranexamic acid (TA) and rectal misoprostol on reducing blood loss during and after cesarean section in low and high-risk groups. Methodology: The study involved 200 pregnant women scheduled for elective cesarean delivery at Beni-Suef University hospital. Participants were randomly divided into two main groups: high-risk and low-risk. Each group was further split into two subgroups: one receiving 400 microgram rectal misoprostol and the other receiving 1 gm (10 ml) (2amp) intravenous tranexamic acid. Post-delivery, all patients received a 10 IU oxytocin (Syntocinon) intravenous bolus. Additional ecbolics (10 IU oxytocin and IM ergometrin) were administered only if blood loss exceeded 500ml or at the surgeon's request. Blood loss was measured post-surgery by weighing pads and monitoring loss during the first 24 hours. Results and Conclusion: Both rectal misoprostol and intravenous tranexamic acid demonstrated comparable effectiveness in reducing blood loss during and after cesarean delivery in both low and high-risk patients for postpartum hemorrhage (PPH). No statistically significant differences were observed among the studied groups regarding the occurrence of postpartum hemorrhage (>1000ml in the first 24 hours) or the neonate's Apgar scores at 1 and 5 minutes. Neither misoprostol nor tranexamic acid side effects were reported.
Keywords
Cesarean section; Rectal Misoprostol; Postpartum hemorrhage; Tranexamic acid
References
  1. Gebhardt GS, Fawcus S, Moodley J, et al.(2015) Maternal death and caesarean section in South Africa: results from the 2011-2013
    Saving Mothers report of the National Committee for
    Confidential Enquiries into Maternal Deaths. S Afr Med J.
    2015;105:287-91.
  2. Bahadur A, Khoiwal K, Bhattacharya N, et al.(2019) The effect of intrauterine misoprostol on blood loss during caesarean section. J Obstet Gynaecol. 2019; 39: 753- 756.
  3. Saccone G, Caissutti C, Ciardulli A, et al.(2013) Uterine massage for preventing postpartum hemorrhage at cesarean delivery: which
    evidence? Eur J Obstet Gynecol Reprod Biol. 2013;223:64-7.
  4. Mannaerts D, Van der Veeken L, Coppejans H, et al. (2015)Adverse effects of carbetocin versus oxytocin in the prevention of
    postpartum haemorrhage after caesarean section: a randomized controlled trial. J Pregnancy.2015;225:1374150
  5. Pattinson RC(2013). Reducing direct causes of maternal death. S Afr J Obstet Gynaecol. 2013;19(3):59-60.
  6. Begley CM, Gyte GM, Devane D et al. (2019): Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2:CD007412.
  7.  Alam A, Choi S.(2016):Prophylactic use of tranexamic acid forpostpartum bleeding outcomes: a systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev.2016;29(4):231-41.
  8. CRASH-2 trial collaborators, Shakur H, Roberts I, et al.(2001) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significanthaemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2001;376(9734):23-32.
  9. Gallos ID, Williams HM, Price MJ et al. (2018): Uterotonic agents for preventing postpartum hemorrhage: a network meta-analysis. Cochrane Database of Systematic Reviews. 4: CD011689.
  10. Elati A and Weeks A (2009): The use of misoprostol in obstetrics and gynecology. BJOG, 116 (1):61–69.
  11. Halder S, Samanta B, Sardar R et al. (2013): Tranexamic acid used before caesarean section reduces blood loss based on pre-and postoperative haemoglobin level: a case-control study. Journal of the Indian Medical Association, 111(3):184-186.
  12. Sahu J and Mishra N (2019): Role of intravenous tranexamic acid in reducing blood loss during caesarean section: Study at tribal-dominated area hospital in Chhattisgarh, India.J Obstet
    Gynaecol Res 45(4):841-848.
  13. Sherafati G, Akhlaghi F and Mostafa K  (2017): Assessment of the effects of tranexamic acid (TXA) in reducing bleeding loss during and after cesarean section (CS). Adv Biores, 8:3.
  14. Christian O. Ogah  ,Chidebe C etal. (2022):  compared  the efficacy of intravenous tranexamic acid versus rectal misoprostol in decreasing in-traoperative blood loss during caesarean section (C/S) :Randomised controlled study, Ghana Medical Journal Vol. 56 No. 2 
Statistics
Article View: 181
PDF Download: 108