Top

The Journal of Obstetrics and Gynecology of India

Published in:

01-06-2019 | Original Article

Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial

Authors: Hamideh Pakniat, Venus Chegini, Azarmidokht Shojaei, Marzieh Beigom Khezri, Iman Ansari

Published in: The Journal of Obstetrics and Gynecology of India | Issue 3/2019

Abstract

Purpose

To evaluate the effects of intravenous tranexamic acid (TA) and sublingual misoprostol on reducing bleeding after cesarean section.

Materials

One hundred and fifty-eight participants with term pregnancies scheduled for cesarean section were randomly divided into two groups. In M group, two sublingual misoprostol pills (400 mg) were administrated, immediately after the delivery. In TA group, ten minutes before skin incision, TA ampoule (1 g) was injected. In both groups, immediately after the delivery, 20 units of oxytocin in 1 L ringer lactate with speed of 1000 CC/h was injected. At the end of the operation, the amount of bleeding was measured based on the number of small and large gauzes, the blood in the suction container and the difference of patient’s hemoglobin before and 24 h after surgery.

Results

Hemoglobin level reduction in the TA group was higher than the M group (− 2.45 ± 0.84 vs − 2.14 ± 1.38 g/dL) (P < 0.001). Furthermore, number of used gauze and blood suction in the TA group was significantly higher compared to sublingual misoprostol (4.67 ± 1.34 vs 3.25 ± 1.31 and 260.25 ± 79.06 vs 193.94 ± 104.79 cc, respectively) (P < 0.001). Mean blood pressure during the entire duration of surgery in the TA group decreased significantly as compared to the M group (P < 0.001).

Conclusion

Total bleeding was significantly lower in sublingual misoprostol as compared to the tranexamic acid group. Furthermore, in misoprostol group hemodynamic variables were stabilized greater than tranexamic acid group.

Registration Number

IRCT201708308611N6

Gebhardt GS, Fawcus S, Moodley J, et al. Maternal death and caesarean section in South Africa: results from the 2011–2013 Saving Mothers report of the National Committee for Confidential Enquiries into Maternal Deaths. S Afr Med J. 2015;105:287–91. https://doi.org/10.7196/SAMJ.9351.CrossRefPubMed

Edwards HM. Aetiology and treatment of severe postpartum haemorrhage. Dan Med J. 2018;65(3).

Saccone G, Caissutti C, Ciardulli A, et al. Uterine massage for preventing postpartum hemorrhage at cesarean delivery: which evidence? Eur J Obstet Gynecol Reprod Biol. 2018;223:64–7. https://doi.org/10.1016/j.ejogrb.2018.02.023.CrossRefPubMed

Mannaerts D, Van der Veeken L, Coppejans H, et al. Adverse effects of carbetocin versus oxytocin in the prevention of postpartum haemorrhage after caesarean section: a randomized controlled trial. J Pregnancy. 2018;2018:1374150. https://doi.org/10.1155/2018/1374150.CrossRefPubMedPubMedCentral

Pattinson RC. Reducing direct causes of maternal death. S Afr J Obstet Gynaecol. 2013;19(3):59–60.

Begley CM, Gyte GM, Devane D, et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2011. https://doi.org/10.1002/14651858.cd007412.pub3.CrossRefPubMedPubMedCentral

Dyer RA, Butwick AJ, Carvalho B. Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist. Curr Opin Anaesthesiol. 2011;24(3):255–61. https://doi.org/10.1097/ACO.0b013e328345331c.CrossRefPubMed

Ducloy-Bouthors AS, Jeanpierre E, Saidi I, et al. TRAnexamic acid in hemorrhagic CESarean section (TRACES) randomized placebo controlled dose-ranging pharmacobiological ancillary trial: study protocol for a randomized controlled trial. Trials. 2018;19(1):149. https://doi.org/10.1186/s13063-017-2421-6.CrossRefPubMedPubMedCentral

Levy JH, Dutton RP, Hemphill JC, et al. Multidisciplinary approach to the challenge of hemostasis. Anesth Analg. 2010;110(2):354–64. https://doi.org/10.1213/ANE.0b013e3181c84ba5.CrossRefPubMed

10.

CRASH-2 trial collaborators, Shakur H, Roberts I, 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. Lancet. 2010;376(9734):23–32. https://doi.org/10.1016/s0140-6736(10)60835-5.CrossRef

11.

Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding outcomes: a systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev. 2015;29(4):231–41. https://doi.org/10.1016/j.tmrv.2015.07.002.CrossRefPubMed

12.

Bouthors AS, Hennart B, Jeanpierre E, et al. Therapeutic and pharmaco-biological, dose-ranging multicentre trial to determine the optimal dose of TRAnexamic acid to reduce blood loss in haemorrhagic CESarean delivery (TRACES): study protocol for a randomised, double-blind, placebo-controlled trial. Trials. 2018;19(1):148. https://doi.org/10.1186/s13063-017-2420-7.CrossRefPubMedPubMedCentral

13.

Sentilhes L, Lasocki S, Ducloy-Bouthors AS, et al. Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaesth. 2015;114(4):576–87. https://doi.org/10.1093/bja/aeu448.CrossRefPubMed

14.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.cd007872.pub3.CrossRefPubMed

15.

Abdel-Aleem H, Alhusaini TK, Abdel-Aleem MA, et al. Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. J Matern Fetal Neonatal Med. 2013;26(17):1705–9. https://doi.org/10.3109/14767058.2013.794210.CrossRefPubMed

16.

Sentürk MB, Cakmak Y, Yildiz G, et al. Tranexamic acid for cesarean section: a double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet. 2013;287(4):641–5. https://doi.org/10.1007/s00404-012-2624-8.CrossRefPubMed

17.

Conde-Agudelo A, Nieto A, Rosas-Bermudez A, et al. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. Am J Obstet Gynecol. 2013;209(1):40.e1–17. https://doi.org/10.1016/j.ajog.2013.03.015.CrossRef

18.

Tunçalp Ö, Hofmeyr GJ, Gülmezoglu AM. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2012. https://doi.org/10.1002/14651858.cd000494.pub4.CrossRefPubMed

19.

Pakniat H, Khezri MB. The effect of combined oxytocin-misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery: a prospective randomized double-blind study. J Obstet Gynaecol India. 2015;65(6):376–81. https://doi.org/10.1007/s13224-014-0607-3.CrossRefPubMedPubMedCentral

20.

Fazel MR, Samimi M, Fakharian E. A comparison of rectal misoprostol and intravenous oxytocin on hemorrhage and homeostatic changes during cesarean section. Middle East J Anesthesiol. 2013;22(1):41–6.PubMed

21.

Sahhaf F, Abbasalizadeh S, Ghojazadeh M, et al. Comparison effect of intravenous tranexamic acid and misoprostol for postpartum haemorrhage. Niger Med J. 2014;55(4):348–53. https://doi.org/10.4103/0300-1652.137228.CrossRefPubMedPubMedCentral

22.

Al-Sawaf A, El-Mazny A, Shohayeb A. A randomised controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum haemorrhage. J Obstet Gynaecol. 2013;33(3):277–9. https://doi.org/10.3109/01443615.2012.755503.CrossRefPubMed

23.

Ugwu IA, Oluwasola TA, Enabor OO, et al. Randomized controlled trial comparing 200 μg and 400 μg sublingual misoprostol for prevention of primary postpartum hemorrhage. Int J Gynaecol Obstet. 2016;133(2):173–7. https://doi.org/10.1016/j.ijgo.2015.09.026.CrossRefPubMed

24.

Othman ER, Fayez MF, El Aal DE, et al. Sublingual misoprostol versus intravenous oxytocin in reducing bleeding during and after cesarean delivery: a randomized clinical trial. Taiwan J Obstet Gynecol. 2016;55(6):791–5. https://doi.org/10.1016/j.tjog.2016.02.019.CrossRefPubMed

25.

Atukunda EC, Siedner MJ, Obua C, et al. Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in Uganda: a double-blind randomized non-inferiority trial. PLoS Med. 2014;11(11):e1001752. https://doi.org/10.1371/journal.pmed.1001752.CrossRefPubMedPubMedCentral

26.

Chaudhuri P, Majumdar A. Sublingual misoprostol as an adjunct to oxytocin during cesarean delivery in women at risk of postpartum hemorrhage. Int J Gynaecol Obstet. 2015;128(1):48–52. https://doi.org/10.1016/j.ijgo.2014.07.029.CrossRefPubMed

27.

Ugwu IA, Enabor OO, Adeyemi AB, et al. Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial. J Obstet Gynaecol. 2014;34(5):407–11. https://doi.org/10.3109/01443615.2014.899329.CrossRefPubMed

28.

Okonofua FE, Ogu RN, Akuse JT, et al. Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: results of a multicenter trial. J Obstet Gynaecol Res. 2014;40(3):718–22. https://doi.org/10.1111/jog.12257.CrossRefPubMed

Title: Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial
Authors: Hamideh Pakniat
Venus Chegini
Azarmidokht Shojaei
Marzieh Beigom Khezri
Iman Ansari
Publication date: 01-06-2019
Publisher: Springer India
Published in: The Journal of Obstetrics and Gynecology of India / Issue 3/2019
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI: https://doi.org/10.1007/s13224-018-1181-x

At a glance: The STEP trials

Springer Medicine

Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial

Abstract

Purpose

Materials

Results

Conclusion

Registration Number

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials

Results

Conclusion

Registration Number

Please log in to get access to this content

Other articles of this Issue 3/2019

Why Institutional Deliveries are Low in Balrampur District Uttar Pradesh: A Cross-Sectional Quantitative and Qualitative Exploration

Book Review for Dr. J.B. Sharma’s “Textbook of Gynecology”

Harlequin Ichthyosis: A Rare Case of Congenital Ichthyosis

Obesity in Pregnancy: Obstetrician’ s Obstacle

Comparison of Effectiveness of Sublingual and Vaginal Misoprostol for Second-Trimester Abortion

Can Epidural Dexamethasone Reduce Patient-Controlled Epidural Consumption of Fentanyl and Levobupivacaine in Laboring Women? A Double-Blind, Randomized, Placebo-Controlled Trial