الفهرس 
CAESAREAN SECTIONOnly 14 pages are availabe for public view
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Abstract
C
aesarean section (CS) rate has increased to as high as 25 to 30% in many areas of the world. Delivery by CS can cause more complications than normal vaginal delivery and one of the most complications is postpartum bleeding, which can be life threatening. To reduce maternal mortality and morbidity caused by bleeding, it’s important to reduce the extent of bleeding during and after CS.
To control the bleeding after CS, some medications such as oxytocin, prostaglandins (E1, E2, F2&) and methylergometrine have been used.
Oral misoprostol appears to be safe and as effective as intravenous oxytocin in reduction of intra-operative blood loss during CS under regional anaesthesia and merits further investigations.
General anaesthesia resulted in significantly more blood loss, lower postoperative haematocrit. Regional anaesthesia is a better choice for CS than general anaesthesia. However the availability of different techniques and ability to change the technique when needed were very useful and important.
Tranexamic acid is a synthetic molecule that exerts its antifibrinolytic action through the reversible blockade of the lysine binding site on plasminogen molecule.
Tranexamic acid has been routinely used for many years to reduce haemorrhage during and after surgical procedures, such as coronary bypass, scoliosis surgery and knee arthroplasty. It has been shown to be very useful for reducing blood loss and the need for blood transfusion. There are some reports on the use of tranexamic acid in prevention of blood loss in many gynecological diseases such as menorrhagia and CS.
The aim of this study is to determine the efficacy of using tranexamic acid preoperatively on decreasing postoperative blood loss after caesarean sections and wither there is a statistically significant difference in the reduction of:
(A) The haematocrit value or
(B)Haemoglobin level and vital signs
The current study was a randomised clinical trial conducted at Ain Shams University maternity hospital, 80 women were included in this study. They were randomly divided into two groups: group I (study group) (n=40) including women who received 1 gm. of tranexamic acid intravenously 10 min before the operation and group II (control group) (n=40) including women who received placebo in the form of 10 ml normal saline solution intravenously.
All the included women ages from 20-40 years old with singleton pregnancy and gestational age from 38-40 weeks, medically free with no allergy to tranexamic acid and spinal anaesthesia was used for all women.
In the current study we excluded any medical problems involving the heart, liver or kidney, neurological disease, blood disorders, history of thromboembolic disorders or pregnancy complications such as preeclampsia, multiple pregnancies, macrosomia, polyhydramnios or placenta previa also women with previous CS was excluded.
For all the included women, initial vital signs (heart rate, respiratory rate, blood pressure) were checked before, 1 hour and 2 hours after the operation and laboratory investigations (haematocrit value, haemoglobin concentration) were performed.
There was statistically significant differences between women who received tranexamic acid and women who received placebo concerning the DROP in haematocrit value (p>0.05) after checking values after 24 hours.
Haemoglobin level was checked 24 hours post-operative and there was statistically significant difference between women who received tranexamic acid and women who received placebo.
Table (18): Comparison between both studied groups regard HCT and HB% after therapy.
P t Tranexamic acid
N=40 Controls
N=40 Variables
NS 0.45 0.6 32+5
(25-40) 31.5+3.3
(27-42) HCT
VHS 0.001 1.8 8.6+3 6.5+2.5 % of change in HCT
NS 0.20 1.2 9.6+1.1
(8-13.3) 10+1.3
(8-13) HB
VHS 0.001 1.9 18+3.6 12.8+3 % of change of HB
Also there were no statistically significant differences between women who received tranexamic acid and women who received placebo concerning vital signs except for the systolic and diastolic blood pressure were there was statistically significant rise in blood pressure in the tranexamic group.
The current study shows that there is significant difference in the blood loss during or after CS that can be concluded from the significant difference in the DROP of the haematocrit valur and haemoglobin percentage between the studied groups.
So tranexamic acid may be used routinely in CS to decrease the amount of blood loss in CS.