Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial
- 44 Downloads
To evaluate the effects of intravenous tranexamic acid (TA) and sublingual misoprostol on reducing bleeding after cesarean section.
One hundred and fifty-eight participants with term pregnancies scheduled for cesarean section were randomly divided into two groups. In M group, two sublingual misoprostol pills (400 mg) were administrated, immediately after the delivery. In TA group, ten minutes before skin incision, TA ampoule (1 g) was injected. In both groups, immediately after the delivery, 20 units of oxytocin in 1 L ringer lactate with speed of 1000 CC/h was injected. At the end of the operation, the amount of bleeding was measured based on the number of small and large gauzes, the blood in the suction container and the difference of patient’s hemoglobin before and 24 h after surgery.
Hemoglobin level reduction in the TA group was higher than the M group (− 2.45 ± 0.84 vs − 2.14 ± 1.38 g/dL) (P < 0.001). Furthermore, number of used gauze and blood suction in the TA group was significantly higher compared to sublingual misoprostol (4.67 ± 1.34 vs 3.25 ± 1.31 and 260.25 ± 79.06 vs 193.94 ± 104.79 cc, respectively) (P < 0.001). Mean blood pressure during the entire duration of surgery in the TA group decreased significantly as compared to the M group (P < 0.001).
Total bleeding was significantly lower in sublingual misoprostol as compared to the tranexamic acid group. Furthermore, in misoprostol group hemodynamic variables were stabilized greater than tranexamic acid group.
KeywordsTranexamic acid Misoprostol Postpartum hemorrhage Cesarean section
This study was supported in part by Kowsar Research Center of Kowsar Hospital, Qazvin University of Medical Sciences. We gratefully acknowledge the Zahra Sadat Mohammadi for assistance with statistical analysis.
Compliance with Ethical Standards
Conflict of interest
The authors declared no conflict of interest. The authors have no financial conflict of interest to declare.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Declaration of Helsinki, as revised in 2008 (5).
Informed consent was obtained from all patients for being included in the study.
- 1.Gebhardt GS, Fawcus S, Moodley J, et al. 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. https://doi.org/10.7196/SAMJ.9351.CrossRefPubMedGoogle Scholar
- 2.Edwards HM. Aetiology and treatment of severe postpartum haemorrhage. Dan Med J. 2018;65(3).Google Scholar
- 4.Mannaerts D, Van der Veeken L, Coppejans H, et al. Adverse effects of carbetocin versus oxytocin in the prevention of postpartum haemorrhage after caesarean section: a randomized controlled trial. J Pregnancy. 2018;2018:1374150. https://doi.org/10.1155/2018/1374150.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Pattinson RC. Reducing direct causes of maternal death. S Afr J Obstet Gynaecol. 2013;19(3):59–60.Google Scholar
- 8.Ducloy-Bouthors AS, Jeanpierre E, Saidi I, et al. TRAnexamic acid in hemorrhagic CESarean section (TRACES) randomized placebo controlled dose-ranging pharmacobiological ancillary trial: study protocol for a randomized controlled trial. Trials. 2018;19(1):149. https://doi.org/10.1186/s13063-017-2421-6.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23–32. https://doi.org/10.1016/s0140-6736(10)60835-5.CrossRefGoogle Scholar
- 12.Bouthors AS, Hennart B, Jeanpierre E, et al. Therapeutic and pharmaco-biological, dose-ranging multicentre trial to determine the optimal dose of TRAnexamic acid to reduce blood loss in haemorrhagic CESarean delivery (TRACES): study protocol for a randomised, double-blind, placebo-controlled trial. Trials. 2018;19(1):148. https://doi.org/10.1186/s13063-017-2420-7.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Pakniat H, Khezri MB. The effect of combined oxytocin-misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery: a prospective randomized double-blind study. J Obstet Gynaecol India. 2015;65(6):376–81. https://doi.org/10.1007/s13224-014-0607-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Atukunda EC, Siedner MJ, Obua C, et al. Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in Uganda: a double-blind randomized non-inferiority trial. PLoS Med. 2014;11(11):e1001752. https://doi.org/10.1371/journal.pmed.1001752.CrossRefPubMedPubMedCentralGoogle Scholar