The Effect Of Prophylactic Intravenous Tranexamic Acid On Blood Loss After Vaginal Delivery In Women At Low Risk Of Postpartum Hemorrhage
Keywords:
Tranexamic Acid, Postpartum Hemorrhage, Vaginal Delivery, Low-Risk Women
Abstract
To determine the impact of prophylactic tranexamic acid (TA) on both calculated and observed blood loss in women undergoing vaginal delivery who are at low risk of postpartum hemorrhage. This double-blind randomized controlled trial involved 140 women with singleton pregnancies, who were randomly assigned to either receive a placebo or one gram of intravenous tranexamic acid (TA) in combination with 10 IU of oxytocin at the time of fetal delivery. Blood loss was estimated based on hematocrit levels measured before delivery and 12–24 hours postpartum. The blood loss was further quantified by measuring the time elapsed from fetal delivery to placental expulsion and from placental expulsion to the conclusion of the second hour after childbirth. The intervention group experienced significantly lower measured blood loss from placental delivery to two hours postpartum (68 (39) vs. 107 (53) mL, P < 0.001) and reduced mean (SD) calculated total blood loss (516 (312) vs. 655 (400) mL, P = 0.036) compared to the control group. However, there was no notable difference between the groups in blood loss from fetal delivery to placental expulsion. Additionally, the frequency of estimated blood loss exceeding 1000 mL was lower in the TA group (8% vs. 19%, P = 0.048). In conclusion, prophylactic use of tranexamic acid benefits women at low risk of postpartum hemorrhage by effectively reducing blood loss after vaginal delivery. Its preventive use could enhance maternal health and mitigate issues related to excessive blood loss.
References
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Movafegh, A., et al. "Effect of Intravenous Tranexamic Acid Administration on Blood Loss During and After Cesarean Delivery." International Journal of Gynecology & Obstetrics, vol. 115, no. 3, 2011, pp. 224–226. https://doi.org/10.1016/j.ijgo.2011.07.009.
Yang, H., et al. "Clinical Study on the Efficacy of Tranexamic Acid in Reducing Postpartum Blood Loss: A Randomized, Comparative, Multicenter Trial." Zhonghua Fu Chan Ke Za Zhi, vol. 36, no. 10, 2001, pp. 590–592.
Gungorduk, K., et al. "Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice with Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study." American Journal of Perinatology, vol. 30, no. 5, 2013, pp. 407–413. https://doi.org/10.1055/s-0032-1326994.
Novikova, N., and G.J. Hofmeyr. "Tranexamic Acid for Preventing Postpartum Haemorrhage." Cochrane Database of Systematic Reviews, vol. 2010, no. 7, 2010, CD007872. https://doi.org/10.1002/14651858.CD007872.pub2.Rouse, D.J., et al. "Criteria for Failed Labor Induction: Prospective Evaluation of a Standardized
Protocol." Obstetrics & Gynecology, vol. 96, no. 5, 2000, pp. 671–677. https://doi.org/10.1016/s0029-7844(00)00991-x.Beigi, A., et al. "Sublingual Misoprostol versus Intravenous Oxytocin in the Management of Postpartum Hemorrhage." Tehran University Medical Journal, vol. 67, no. 8, 2009, pp. 556–561.Stafford, I., et al.
"Visually Estimated and Calculated Blood Loss in Vaginal and Cesarean Delivery." American Journal of Obstetrics and Gynecology, vol. 199, no. 5, 2008, p. 519.e1-7. https://doi.org/10.1016/j.ajog.2008.04.049.Gohel, M., et al. "Efficacy of Tranexamic Acid in Decreasing Blood Loss During and After Cesarean Section: A Randomized Case Controlled Prospective Study." The Journal of Obstetrics and Gynecology of India, vol. 57, 2007, pp. 228–230.
Milman, N. "Postpartum Anemia: Definition, Prevalence, Causes, and Consequences." Annals of Hematology, vol. 90, no. 11, 2011, pp. 1247–1253. https://doi.org/10.1007/s00277-011-1279-z.
World Health Organization. "WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta, 2009." World Health Organization, 2009, http://www.int/entity/reproductive_health/publications/maternal_perinatal_health/9789241598514/en/23k.
Ramanathan, G., and S. Arulkumaran. "Postpartum Haemorrhage." Current Obstetrics & Gynecology, vol. 16, no. 1, 2006, pp. 6–13. https://doi.org/10.1016/j.curobgyn.2005.11.002.
Oyelese, Y., et al. "Postpartum Hemorrhage." Obstetrics and Gynecology Clinics of North America, vol. 34, no. 3, 2007, pp. 421–441. https://doi.org/10.1016/j.ogc.2007.06.008.
Mousa, H.A., and Z. Alfirevic. "Treatment for Primary Postpartum Haemorrhage." Cochrane Database of Systematic Reviews, vol. 2007, no. 1, 2007, CD003249. https://doi.org/10.1002/14651858.CD003249.pub2.
Kaewpradub, P., et al. "Does Tranexamic Acid in an Irrigating Fluid Reduce Intraoperative Blood Loss in Orthognathic Surgery? A Double-Blind, Randomized Clinical Trial." Journal of Oral and Maxillofacial Surgery, vol. 69, no. 6, 2011, pp. 186–189. https://doi.org/10.1016/j.joms.2010.12.013.
Imai, N., et al. "Tranexamic Acid for Reduction of Blood Loss During Total Hip Arthroplasty." The Journal of Arthroplasty, vol. 27, no. 10, 2012, pp. 1838–1843. https://doi.org/10.1016/j.arth.2012.05.012.
Williams-Johnson, J.A., 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." West Indian Medical Journal, vol. 59, no. 6, 2010, pp. 612–624.
Roberts, I., and K. Ker. "Tranexamic Acid for Postpartum Bleeding." International Journal of Gynecology & Obstetrics, vol. 115, no. 3, 2011, pp. 220–221. https://doi.org/10.1016/j.ijgo.2011.07.006.
Shakur, H., et al. "The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic Acid for the Treatment of Postpartum Haemorrhage: An International Randomised, Double Blind Placebo Controlled Trial." Trials, vol. 11, 2010, p. 40. https://doi.org/10.1186/1745-6215-11-40.
Sekhavat, L., et al. "Efficacy of Tranexamic Acid in Reducing Blood Loss After Cesarean Section." The Journal of Maternal-Fetal & Neonatal Medicine, vol. 22, no. 1, 2009, pp. 72–75. https://doi.org/10.1080/14767050802350995.
Gai, M.Y., et al. "Clinical Observation of Blood Loss Reduced by Tranexamic Acid During and After Caesarian Section: A Multi-Center, Randomized Trial." European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 112, no. 2, 2004, pp. 154–157. https://doi.org/10.1016/s0301-2115(03)00287-2.
anaka, N., et al. "Timing of the Administration of Tranexamic Acid for Maximum Reduction in Blood Loss in Arthroplasty of the Knee." The Journal of Bone and Joint Surgery. British Volume, vol. 83-B, no. 5, 2001, pp. 702–705. https://doi.org/10.1302/0301-620X.83B5.11745.
Xu, J., et al. "Tranexamic Acid for the Prevention of Postpartum Hemorrhage After Cesarean Section: A Double-Blind Randomization Trial." Archives of Gynecology and Obstetrics, vol. 415, no. 5, 2012, pp. 124–127. https://doi.org/10.1007/s00404-012-2357-z.
Gungorduk, K., et al. "Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss After Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study." American Journal of Perinatology, vol. 28, no. 3, 2011, pp. 233–240. https://doi.org/10.1055/s-0030-1268238.
Senturk, M.B., et al. "Tranexamic Acid for Cesarean Section: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial." Archives of Gynecology and Obstetrics, vol. 287, no. 4, 2013, pp. 641–645. https://doi.org/10.1007/s00404-012-2624-z.
Movafegh, A., et al. "Effect of Intravenous Tranexamic Acid Administration on Blood Loss During and After Cesarean Delivery." International Journal of Gynecology & Obstetrics, vol. 115, no. 3, 2011, pp. 224–226. https://doi.org/10.1016/j.ijgo.2011.07.009.
Yang, H., et al. "Clinical Study on the Efficacy of Tranexamic Acid in Reducing Postpartum Blood Loss: A Randomized, Comparative, Multicenter Trial." Zhonghua Fu Chan Ke Za Zhi, vol. 36, no. 10, 2001, pp. 590–592.
Gungorduk, K., et al. "Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice with Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study." American Journal of Perinatology, vol. 30, no. 5, 2013, pp. 407–413. https://doi.org/10.1055/s-0032-1326994.
Novikova, N., and G.J. Hofmeyr. "Tranexamic Acid for Preventing Postpartum Haemorrhage." Cochrane Database of Systematic Reviews, vol. 2010, no. 7, 2010, CD007872. https://doi.org/10.1002/14651858.CD007872.pub2.Rouse, D.J., et al. "Criteria for Failed Labor Induction: Prospective Evaluation of a Standardized
Protocol." Obstetrics & Gynecology, vol. 96, no. 5, 2000, pp. 671–677. https://doi.org/10.1016/s0029-7844(00)00991-x.Beigi, A., et al. "Sublingual Misoprostol versus Intravenous Oxytocin in the Management of Postpartum Hemorrhage." Tehran University Medical Journal, vol. 67, no. 8, 2009, pp. 556–561.Stafford, I., et al.
"Visually Estimated and Calculated Blood Loss in Vaginal and Cesarean Delivery." American Journal of Obstetrics and Gynecology, vol. 199, no. 5, 2008, p. 519.e1-7. https://doi.org/10.1016/j.ajog.2008.04.049.Gohel, M., et al. "Efficacy of Tranexamic Acid in Decreasing Blood Loss During and After Cesarean Section: A Randomized Case Controlled Prospective Study." The Journal of Obstetrics and Gynecology of India, vol. 57, 2007, pp. 228–230.
Published
2024-12-23
How to Cite
Alobaidy, E., & Essa, S. (2024). The Effect Of Prophylactic Intravenous Tranexamic Acid On Blood Loss After Vaginal Delivery In Women At Low Risk Of Postpartum Hemorrhage. Central Asian Journal of Medical and Natural Science, 6(1), 169-178. Retrieved from https://cajmns.centralasianstudies.org/index.php/CAJMNS/article/view/2684
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