Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Abstract

Background: Delivery bleeding is still a major catastrophe that facing most of obstetricians, leading to global maternal exhaustion and fatality. So estimation of the blood loss and the changes occurring during the procedure are important in the management of the bleeding. Aim of the study: : Comparing loss of blood during Cesarean Delivery, Intra and post-operative in parturients, injected by Oxytocin versus Tranexamic acid with Ethamsylate. Patients and Methods: Blinded randomized controlled trial, whereas 200 of Gravid women shared and equally distributed to double collections, each collection includes 100 of women and Each of them is injected with Syntocinon 5 IU infusion on 500 cc saline 0.9%, at rate of 100cm/hour Or Tranexamic acid with Ethamsylate, 5 to 10 min IV slowly before the abdominal delivery, with evaluation of the bleeding amount.Results: Blood loss amount, participants requiring for blood transfer OR more intervention, were minimal in the tranexamic acid and ethamsylate collection than in the oxytocin collection. Moreover the results of hemoglobin and hematocrit postoperatively were elevated in the participants who injected by both tranexamic acid and ethamsylate comparing with the participants who injected by the Syntocinon. Conclusion:The Evaluated variables with the positive and negative results of the research medications, demonstrated the following: Both Tranexamic acid and Ethamsylate could be effective than Oxytocin in minimizing the demand for blood transfer, with the stability of both hematologic profile and the hemodynamics. And both too, appear to be safe and efficient option in the management of the abdominal delivery.

Perioperative oxytocin infusion versus tranexamic acid and ethamsylate in reducing intraoperative blood loss during caesarean section: a systematic review and meta-analysis

“…In this study of intraoperative blood loss, the TXAEth group demonstrated significantly lower intraoperative blood loss than the oxytocin group. This result is consistent in all included studies [19][20][21]. It is affirmed that TXA and Eth are associated with a significant reduction in intraoperative blood loss compared to a placebo [22].…”

“…Although a statistically significant distinction in postoperative hematocrit levels was observed between the two cohorts, there was no analogous difference in hemoglobin levels. Nevertheless, the decline in both Hb (-0.5 ± 0.2 and -1.77 ± 1.16 vs -0.9 ± 0.2 and -1.78 ± 1.12) and Hct (-1.5 ± 1.4 and -5.84 ± 3.91 vs -2.57 ± 1.6 and -5.84 ± 3.91) was less pronounced in the TXAEth group compared to the oxytocin group (Table 2) [19,21]. This implies that TXAEth might exhibit greater efficacy in mitigating blood loss during surgical procedures.…”

Comparative study between oxytocin and combination of tranexamic acid and ethamsylate in reducing intra-operative bleeding during emergency and elective cesarean section after 38 weeks of normal pregnancy

“…Limited studies focused on the efficacy of the combined tranexamic acid and ethamsylate versus oxytocin in reducing blood loss during and after CS. First, a similar trial carried out in Egypt by Abdelazim et al [ 19 ] – a blind randomized control trial conducted on 200 pregnant women – showed that receiving one gram of tranexamic acid with 250 mg of ethamsylate safely reduced the intraoperative and postoperative bleeding in women undergoing elective CS than 5 IU oxytocin infusion on 500 ml saline 0.9%. In Hassan et al 2020, 138 pregnant women were recruited and randomized into three groups given either 10 IU oxytocin over one minute in addition to 40 IU oxytocin infusion in 500 ml of 0.9% normal saline over four hours after delivery (intervention: oxytocin bolus and infusion), an intravenous slow bolus of 10 IU oxytocin + one gram of tranexamic acid in 200 ml of 0.9% normal saline over five minutes after delivery (intervention: oxytocin bolus and tranexamic acid infusion), or one intravenous slow 10 IU oxytocin bolus alone (placebo: only oxytocin bolus) [ 20 ].…”

“…Some relevant studies discussed similar outcomes of the combined tranexamic acid and ethamsylate versus oxytocin. Abdelazim et al [ 19 ] showed that receiving tranexamic acid with ethamsylate significantly reduced the need for blood transfusion. They also found that the postoperative hematocrit and hemoglobin values were significantly higher in tranexamic acid combined with ethamsylate than in the oxytocin group, whereas the reduction of these values was lower in tranexamic acid with ethamsylate than oxytocin.…”

Tranexamic Acid Versus Etamsylate in Reducing Blood Loss During Normal Vaginal Delivery in Patients with High Risk of Postpartum Hemorrhage: Randomized Controlled Trial

“…These results were enhanced by the study of Mohamed et al where the blood loss quantity, blood transfusion requirement or further intervention, were minimal in the users of tranexamic acid and etamsylate than in the oxytocin users. Additionally, the values of Hb and hematocrit post-surgically were high in the women who received both tranexamic acid and etamsylate comparing with those received syntocinon (17) .…”