Local Versus Systemic Use of Tranexamic Acid in Elective Cesarean Section

Abstract Background: Obstetric hemorrhage remains one of the major determinants of maternal death in both developed and developing countries. Because of its weight as a leading cause of maternal mortality and morbidity. Hemostatic drugs are not usually used as first-line treatment in post-partum hemor-rhage (PPH). It was authenticated that extensive tissue injury can direct the hemostatic equilibrium toward increased fibri-nolysis, leading to coagulopathy and bleeding. Antifibrinolytic drugs, named tranexamic acid (TXA) have been recognized to decrease blood loss and transfusion needs in various elective surgeries. Aim of Study: Evaluating the role of adjunctive IV Tran-examic acid versus topical Tranexamic acid infusion of the placental bed to prevent the postpartum hemorrhage. Patients and Method: It was a randomized clinical trial that extended from January 2019 to January 2020 and was done at Mansoura University Hospital, Obstetrics and Gyne-cology Department and it included a total of 164 pregnant subjects planning for cesarean section who were randomly divided into two groups; the initial group included cases who were subjected to local tranexamic acid administration (2gm), and the other one included cases who were commenced on the intravenous form (1gm). Before operation, all subjects were subjected to complete history taking, fulllaboratory investigations, detailed obstetric examination, and pelviab-dominal ultrasound. Cesarean section was performed in all cases using the standard procedure. Results: The mean age of the included cases was 35.3 and 33.89 years in the local and systemic groups respectively. There was no significant difference between the two groups regarding parity, number of gestations, the indication of cesarean section and the mean operative time. Blood loss was significantly increased in the systemic group versus local group (p < 0.001), hemoglobin levels showed significant de-crease in the systemic group. The change in both hemoglobin and hematocrit levels was significantly higher in the systemic group (p < 0.001). Conclusion: It is apparent that topical administration of TXA is associated with more effective to decrease blood lossv and causes less change in hematological parameters compared to its intravenous administration.