Role of Tranexamic Acid in Control of Intraoperative Blood Loss in Women Undergoing Elective Cesarean Section

Abstract

Objectives: To compare the mean intraoperative blood loss in pregnant mothers undergoing elective cesarean section after prophylactic tranexamic acid versus 5% glucose (placebo).

Methodology: This double blind, randomized controlled trial study was conducted in department of Obstetrics and gynaecology, Combined Military Hospital Multan from November 2023 to April 2024. Sixty-eight pregnant women aged 20-45 years, at 37-40 weeks of gestation and scheduled for cesarean delivery under spinal anesthesia were consecutively enrolled in the study. Participants were equally randomized to receive either 1g intravenous tranexamic acid or 5% dextrose placebo fifteen minutes before surgery. Intraoperative bleeding was measured using the weight difference of surgical gauze / towels and suction volume. Data were analyzed using SPSS version 23. Mean ± SD for quantitative data and frequency and percentages for categorical data are reported. The independent sample t-test is applied for blood loss comparison between the groups. P-value <0.05 is taken significant.

Results: The maternal age was 32.4±5.1 years and mean gestational age was 37.8±1.3 weeks. The groups were comparable in baseline characteristics except for a higher median number of previous cesareans in placebo group (2 versus 1, p = 0.014). Mean loss of blood was substantially less in tranexamic acid group (501.5±143.8 ml) compared to placebo (813.2± 264.9 ml; p < 0.001). This difference remained after stratification, though not statistically significant among women with last vaginal delivery (p=0.068) or no cesarean section ever (p=0.078).

Conclusion: Prophylactic administration of tranexamic acid reduced intraoperative blood loss significantly during cesarean deliveries.

Key Words: Cesarean section, Tranexamic acid, Blood loss.