| 摘要 |
Background: Worldwide, 21% of deliveries are by elective cesarean sections (C/S) as a procedure to reduce maternal
and neonatal mortality and morbidity. Blood loss during C/Ss is more than vaginal delivery. Therefore, reducing
blood loss during the C/Ss is essential and challenging for anesthesiologists and obstetricians. This study aimed
to assess the efficacy of intravenous oxytocin versus tranexamic acid + ethamsylate (TXA + Eth) in reducing
blood loss in pregnant women at high risk of primary PPH undergoing elective lower‑segment cesarean section.
Materials and Methods: A single‑center, prospective, randomized, and double‑blind study was started after
obtaining institutional ethical approval. The study involved women undergoing elective C/Ss at full‑term
pregnancy at high risk for primary postpartum hemorrhage (PPH) at the SAMSRI between September 2021
and March 2022. The study participants received an infusion of either oxytocin 10 International Unit or TXA
1 g + Eth 250 mg before the skin incision. The primary outcome was the blood loss calculation, alongside
hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of
participants who progressed into primary PPH and required blood transfusion.
Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly
reduced bleeding during and after cesarean section in pregnant women at high risk for PPH. In oxytocin
and TXA + Eth groups, postoperative blood loss was (613.7 ± 123.7 and 406.2 ± 116.5) ml, respectively,
P < 0.001. The duration of surgery in oxytocin and TXA + Eth groups were (48.5 ± 9.3) and (44.3 ± 9.8)
minutes, respectively (P = 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups
were 10.69% and 0.75%, respectively (P = 0.023). The PPH in the oxytocin and TXA + Eth groups were
2.30% and 0%, respectively (p < 0.017). Pre‑ and postoperative hemoglobin and hematocrit values at 24 h
after cesarean section in the oxytocin (10.78 and 8.29) and (32.23 + 25.10) and TXA + Eth groups were
(11.07 and 10.02) and (33.20 and 30.73), respectively (P < 0.001).
Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss, and
the demand for blood transfusion after cesarean section. |
