Role of Tranexamic Acid in Reducing Blood Loss in Vaginal Delivery

Abstract

Introduction Anti-fibrinolytic agents are used to reduce obstetric blood loss as the fibrinolytic system is known to get activated after placental delivery. Objectives To evaluate the efficacy of parenteral tranexamic acid in reducing blood loss during normal labour and to compare it with the amount of blood loss in patients who received placebo in the third stage of labour. Methodology Patients with spontaneous labour or planned for induction of labour and fulfilling the inclusion criteria were recruited for the study. In each patient, the pre-delivery pulse rate, blood pressure, Hb gm% and PCV% were noted. Labour was monitored carefully using a partogram. The study group received Inj. Oxytocin and Inj. Tranexamic acid. The control group received Inj. Oxytocin and Placebo injection. Immediately after delivery of the baby, when all the liquor was drained, the patient was 123 placed over a blood drape-a disposable conical, graduated plastic collection bag. The amount of blood collected in the blood drape was measured. Then the patient was given preweighed pads, which were weighed 2 h post-partum. The blood loss was measured by measuring the blood collected in the drape and by weighing the swabs before and after delivery. Results The total number of patients studied was 100-equally distributed in both the groups. The age group of the patients and BMI were comparable. There was a significant increase in the pulse rate and decrease in blood pressure in the control group as compared with the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group as compared to the study group. The mean blood loss at the end of 2 h was 105 ml in the study group and 252 ml in the control group. There was a significant increase in the usage of uterotonics and also in the need for blood transfusion in the control group; 12 % of the patients in the control group had to stay for more than 3 days compared to 2 % in the study group. Conclusion Tranexamic acid injection, an antifibrinolytic agent when given prophylactically after the delivery of the baby, by intravenous route appears to reduce the blood loss and maternal morbidity during normal labour effectively.

Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?

“…37 Hence in our study, TXA was administered in the dose of 15 mg/kg body weight, immediately after cord clamping. to the studies by Ferrer et al and Roy et al 22,38 Both the groups had similar duration of third stage of labour.…”

“…14,21,38 There were a significant drop in Hb% and hematocrit values in both group T (1.22 g%, 3.24%) and group P (1.57 g%, 4.62%). The fall was significantly greater in group P compared to group T. Similar observation were made by Li et al, Gungorduk et al, Saccone et al, Ismail et al, Roy et al and El-Garhy et al 19,20,27,32,38,39 Accordingly, the estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P (398.23 ml) compared to group T (311.24 ml). Saccone et al in their metaanalysis including 4671 participants, had evaluated TXA within 10 min after vaginal delivery and found a significantly lower blood loss with mean difference of 84.74 ml.…”

Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

“…There was a statistically significant change in vital parameters which are in concurrence with similar studies carried out earlier. 26,27 There was a statistically significant fall in Hb% in the control group as compared to the study group in Mean blood loss from the time of delivery to 2 hours was 191 ml in study group and 277 ml in control group. These results were in agreement with previous studies carried out elsewhere.…”

The effect of tranexamic acid on blood loss after vaginal delivery

“…Gungorkuk et al did a randomized trial in 439 patients undergoing normal delivery and there was a significant decrease in blood loss in tranexamic group compared to placebo group. 11 In 2015, Priyankur Roy et al conducted a study to find out the efficacy of tranexamic acid in the reduction of blood loss after delivery. 14 The study found good reduction in blood loss with the use of tranexamic acid.…”

“…8 Many studies have suggested that tranexamic acid is reducing blood loss after delivery. [9][10][11] Tranexamic acid is a very easily available drug and is cheap. Though there are concerns about thrombosis with the use of this drug there are many studies which suggested that the drug can be safely used without the risk of thrombosis.…”