全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Effect of Intravenous Tranexamic Acid in Reducing Blood Loss during and after Elective Caesarean Section in a Third Level Health Institution: A Randomized Controlled Study

DOI: 10.4236/ojog.2023.132028, PP. 265-279

Keywords: Tranexemic Acid, Blood Loss, Elective Caesarean Section, Port Harcourt

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, and is one of the direct causes of maternal mortality and morbidity globally. Tranexamic acid is recommended in the treatment of postpartum haemorrhage (PPH) if oxytocin and other utertonics are ineffective in controlling PPH. In this centre it is not used prophylactically to reduce blood during caesarean section. Aim: To assess the effect of prophylactic intravenous tranexamic acid on blood loss during and after elective C/S at the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective, single-blind, randomized, placebo-controlled interventional study conducted at the Obstetric theatre of UPTH from July 2020 to March 2021. Eligible women were randomized into two groups; seventy-two women received intravenous tranexamic acid while seventy-one women received a placebo. Socio-demographic data and the result of the study were collected through a proforma. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) Version 22.0. The results were expressed in tables and charts as frequencies, percentages and mean. Chi-square test, Fisher’s exact, and T-test were used to determine the relationship between variables. P-value ≤ 0.05 was considered statistically significant. Results: The findings showed that tranexamic acid significantly reduced mean blood loss during and after C/S (p-value < 0.01). The mean total blood loss from C/S to 2 hours post-surgery was significantly lower in the tranexamic acid group (624.88 ± 200.76 ml) in comparison to the placebo group (864.24 ± 229.09 ml), p-value = 0.001. The mean post-C/S packed cell volume (PCV) was significantly higher among the tranexamic acid group (30.68% ± 2.80%) in comparison to the placebo group (28.07% ± 3.27%), t = 5.131, p-value = 0.0001. The maternal side effects were nausea and vomiting, 9 (12.5%) and 1 (1.4%) participants respectively. Conclusion:

References

[1]  Incerpi, M.H. (2013) Operative Delivery. In: Decherney, A.H., Nathan, L., Laufer, N. and Roman, A.S., Eds., Current Diagnosis and Treatment in Obstetrics and Gynaecology, 11th Edition, McGraw-Hills Company Inc., New York, 609-634.
[2]  Gupta, M., Vandana Saini. (2018) Caesarean Section: Mortality and Morbidity. Journal of Clinical and Diagnostic Research, 12, QE01-QE06.
https://doi.org/10.7860/JCDR/2018/37034.11994
[3]  Betran, A.P., Torloni, M.R., Zhang, J.J. and Gulmezoglu, A.M. (2015) WHO Statement on Caesarean Section Rates: A Commentary. Br JOG.
[4]  Maswime, S. and Buchmann, E.J. (2017) Why Women Bleed and How They Are Saved: A Cross-Sectional Study of Caesarean Section Near-Miss Morbidity. BMC Pregnancy and Childbirth, 17, 15.
https://doi.org/10.1186/s12884-016-1182-7
[5]  WHO (2012) Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. WHO, Geneva.
[6]  Abouzahr, C. (2003) Global Burden of Maternal Death and Disability. British Medical Bulletin, 67, 1-11.
https://doi.org/10.1093/bmb/ldg015
[7]  Green, K.I., Ojule, J.D. and Mmom, F.C. (2015) Primary Postpartum Haemorrhage at the University of Port Harcourt Teaching Hospital: Prevalence and Risk Factors. The Nigerian Health Journal, 15, 111-117.
[8]  Nonye-Enyindah, E., Oranu, E.O. and Enyindah, N.S. (2020) Effect of Blood Loss on Packed Cell Volume Following Elective Caesarean Section at a Tertiary Hospital, Southern Nigeria. JMSC, 8, 118-128.
[9]  Sarah, B.H. and Poggi, M.D. (2013) Postpartum Haemorrhage and the Abnormal Peurperium. In: Decherney, A.H., Nathan, L., Laufer, N. and Roman, A.S., Eds., Current Diagnosis and Treatment in Obstetrics and Gynaecology, 11th Edition, McGraw-Hills Company Inc., New York, 635-666.
[10]  Royal College of Obstetrics and Gynaecologists (2011) Prevention and Management of Postpartum Haemorrhage. Green-Top Guideline No. 52, RCOG, London.
[11]  WHO (2005) Attending to 136 Million Births Every Year, Make Every Mother and Child Count. World Health Organization, Geneva, 62-63.
[12]  Sentilhes, L., Lasocki, S., Ducloy-Bouthors, A.S., et al. (2015) Trenexamic Acid for the Prevention and Treatment of Postpartum Haemorrhage. British Journal of Anaesthesia, 114, 576-587.
https://doi.org/10.1093/bja/aeu448
[13]  Novikova, N., Hofmeyr, G.J. and Cluver, C. (2015) Tranexamic Acid for Preventing Postpartum Haemorrhage. Cochrane Database of Systematic Reviews, No. 6, CD-007872.
https://doi.org/10.1002/14651858.CD007872.pub3
[14]  Gillissen, A., Henriquez, D.D.C.A., Van den Akker, T., et al. (2017) The Effect of Tranexamic Acid on Blood Loss and Maternal Outcome in the Treatment of Persistent Postpartum Haemorrhage: A Nationwide Retrospective Cohort Study. PLOS ONE, 12, e0187555.
https://doi.org/10.1371/journal.pone.0187555
[15]  Oyelese, Y. and Ananth, C.V. (2010) Postpartum Haemorrhage: Epidemiology, Risk Factors, and Causes. Clinical Obstetrics and Gynecology, 53, 147-156.
https://doi.org/10.1097/GRF.0b013e3181cc406d
[16]  Shakur, H., Roberts, I., Bautista, R., et al. (2010) Effects of Tranexamic Acid on Death, Vascular Occlusive Events, and Blood Transfusion in Trauma Patients with Significant Haemorrhage (CRASH-2): A Randomized, Placebo-Controlled Trial. The Lancet, 376, 23-32.
https://doi.org/10.1016/S0140-6736(10)60835-5
[17]  WOMAN Trial Collaborators (2017) Effect of Early Tranexamic Acid Administration on Mortality, Hysterectomy, and Other Morbidities in Women with Post-Partum Haemorrhage (WOMAN): An International, Randomized, Double-Blind, Placebo-Controlled Trial. The Lancet, 389, 2105-2116.
https://doi.org/10.1016/S0140-6736(17)30638-4
[18]  Cohen, M.J. and Christie, S.A. (2017) Coagulopathy of Trauma. Critical Care Clinics, 33, 101-118.
https://doi.org/10.1016/j.ccc.2016.08.003
[19]  Tengborn, I., Blomback, M. and Berntorp, E. (2015) Tranexamic Acid—An Old Drug Still Going Strong and Making a Revival. Thrombosis Research, 135, 231-242.
https://doi.org/10.1016/j.thromres.2014.11.012
[20]  Franchini, M., Mengoli, C., Cruciani, M., Bergamini, V., Presti, F., Marano, G., et al. (2018) Safety and Efficacy of Tranexamic Acid for Prevention of Obstetric Haemorrhage: An Updated Systematic Review and Meta-Analysis. Blood Transfusion, 16, 329-337.
[21]  Rossaint, R., Bouillon, B., Cerny, V., et al. (2010) Management of Bleeding Following Major Trauma: An Updated European Guideline. Critical Care, 14, R52.
https://doi.org/10.1186/cc8943
[22]  Annual Report of the Department of Obstetrics and Gynaecology of the Univerity of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, 2020.
[23]  Movafegh, A., Eslamian, I. and Dorabadi, A. (2011) Effect of Intravenous Tranexamic Acid Administration on Blood Loss during and after Caesarean Delivery. International Journal of Gynecology & Obstetrics, 115, 224-226.
https://doi.org/10.1016/j.ijgo.2011.07.015
[24]  Gai, M.Y., Wu, L.F., Su, Q.F. and Tatsumoto, K. (2004) Clinical Observation of Blood Loss Reduced by Tranexamic Acid during and after Caesarean Section: A Multi-Center, Randomized Trial. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 112, 144-157.
https://doi.org/10.1016/S0301-2115(03)00287-2
[25]  Roy, I., Chakraborty, S. and Mukhopadhyay, S. (2018) Role of Intravenous Tranexamic Acid on Caesarean Blood Loss: A Prospective Randomized Study. Tropical Journal of Obstetrics and Gynaecology, 35, 49-53.
https://doi.org/10.4103/TJOG.TJOG_1_16
[26]  Xu, J., Gao, W. and Ju, Y. (2013) Tranexamic Acid for the Prevention of Postpartum Haemorrhage after Caesarean Section: A Double-Blind Randomization Trial. Archives of Gynecology and Obstetrics, 287, 463-468.
https://doi.org/10.1007/s00404-012-2593-y
[27]  Oseni, R.O., Zakari, M., Adamou, N. and Umar, U.S. (2021) Effectiveness of Preoperative Tranexamic Acid in Reducing Blood Loss during Caesarean Section at Aminu Kano Teaching Hospital, Kano: A Randomized Controlled Trial. Pan African Medical Journal, 39, 34.
https://doi.org/10.11604/pamj.2021.39.34.21938
[28]  Obi, V.O., Umeora, O.U.J., Dimejesi, B.O., et al. (2019) Efficacy of Intravenous Tranexamic Acid at Reducing Blood Loss during Elective Caesarean Section in Abakaliki: A Double Blind Randomized Placebo Controlled Trial. African Journal of Health Sciences, 18, 10-17.
[29]  Halifa, I.S., Olusesan, T.A., Fawole, B. and Oladokun, A. (2021) Intravenous Tranexamic Acid for Reducing Blood Loss during Caesarean Delivery: A Double-Blind, Randomized-Controlled Trial. New Nigerian Journal of Clinical Research, 10, 40-46.
https://doi.org/10.4103/nnjcr.nnjcr_25_20

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133