Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial
Abstract Objective This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (C...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-023-05935-5 |
| _version_ | 1827632768873398272 |
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| author | Mariam Dawoud Maha Al-Husseiny Omneya Helal Moutaz Elsherbini Mazen Abdel-Rasheed Mona Sediek |
| author_facet | Mariam Dawoud Maha Al-Husseiny Omneya Helal Moutaz Elsherbini Mazen Abdel-Rasheed Mona Sediek |
| author_sort | Mariam Dawoud |
| collection | DOAJ |
| description | Abstract Objective This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (CS). Methods About 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values. Results Both tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P < 0.001 and − 3.05 ± 1.28 vs. -3.06 ± 1.13 vs. -4.94 ± 1.82%, P < 0.001 respectively). In addition, the estimated blood loss was significantly lower in the tranexamic and misoprostol groups compared to the control group (641.6 ± 271.9 vs. 617.9 ± 207.4 vs. 1002.4 ± 340.7 ml, P < 0.001). Conclusion Both tranexamic acid and misoprostol are equally capable of reducing blood loss, but the results were significantly better compared to using oxytocin alone in high-risk patients. Clinical Trial Registration Registered at www.clinicaltrials.govon07/10/2019 with registration number NCT04117243. |
| first_indexed | 2024-03-09T14:50:13Z |
| format | Article |
| id | doaj.art-450372bd32c84c139519faea90ef416d |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-09T14:50:13Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-450372bd32c84c139519faea90ef416d2023-11-26T14:30:52ZengBMCBMC Pregnancy and Childbirth1471-23932023-08-012311710.1186/s12884-023-05935-5Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trialMariam Dawoud0Maha Al-Husseiny1Omneya Helal2Moutaz Elsherbini3Mazen Abdel-Rasheed4Mona Sediek5Obstetrics and Gynaecology Department, Faculty of Medicine, Cairo UniversityObstetrics and Gynaecology Department, Faculty of Medicine, Cairo UniversityObstetrics and Gynaecology Department, Faculty of Medicine, Cairo UniversityObstetrics and Gynaecology Department, Faculty of Medicine, Cairo UniversityReproductive Health Research Department, National Research CentreObstetrics and Gynaecology Department, Faculty of Medicine, Cairo UniversityAbstract Objective This study compares the effectiveness of administering sublingual misoprostol combined with oxytocin to that of IV tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss in high-risk women for postpartum haemorrhage (PPH) following cesarean section (CS). Methods About 315 high-risk pregnant women undergoing CS participated in this trial. They were randomly assigned into three groups; tranexamic group, misoprostol group, and control group, according to the medication given in the operative theatre. All patients received oxytocin intraoperatively. They were assessed regarding intraoperative blood loss, the incidence of PPH, and the reduction in haemoglobin and hematocrit values. Results Both tranexamic and misoprostol groups had similar results in reducing intra and post-operative blood loss. However, the reduction in haemoglobin and hematocrit were significantly lower in tranexamic and misoprostol groups compared to the control group (-0.78 ± 0.57 vs. -0.83 ± 0.52 vs. -1.32 ± 0.57 gm/dl, P < 0.001 and − 3.05 ± 1.28 vs. -3.06 ± 1.13 vs. -4.94 ± 1.82%, P < 0.001 respectively). In addition, the estimated blood loss was significantly lower in the tranexamic and misoprostol groups compared to the control group (641.6 ± 271.9 vs. 617.9 ± 207.4 vs. 1002.4 ± 340.7 ml, P < 0.001). Conclusion Both tranexamic acid and misoprostol are equally capable of reducing blood loss, but the results were significantly better compared to using oxytocin alone in high-risk patients. Clinical Trial Registration Registered at www.clinicaltrials.govon07/10/2019 with registration number NCT04117243.https://doi.org/10.1186/s12884-023-05935-5MisoprostolOxytocinPostpartum haemorrhageTranexamic acid |
| spellingShingle | Mariam Dawoud Maha Al-Husseiny Omneya Helal Moutaz Elsherbini Mazen Abdel-Rasheed Mona Sediek Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial BMC Pregnancy and Childbirth Misoprostol Oxytocin Postpartum haemorrhage Tranexamic acid |
| title | Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial |
| title_full | Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial |
| title_fullStr | Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial |
| title_full_unstemmed | Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial |
| title_short | Intravenous tranexamic acid vs. sublingual misoprostol in high-risk women for postpartum haemorrhage following cesarean delivery; a randomised clinical trial |
| title_sort | intravenous tranexamic acid vs sublingual misoprostol in high risk women for postpartum haemorrhage following cesarean delivery a randomised clinical trial |
| topic | Misoprostol Oxytocin Postpartum haemorrhage Tranexamic acid |
| url | https://doi.org/10.1186/s12884-023-05935-5 |
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