Publication:

Efficacy and safety of tranexamic acid in reducing blood loss in lower segment caesarean section: a prospective, randomised, double-blind and case-controlled study

Background Cesarean section (CS) rates are rising globally, and postpartum haemorrhage remains a major cause of maternal morbidity. Tranexamic acid (TXA), an antifibrinolytic agent, has been shown to reduce bleeding in various surgical settings, but its routine prophylactic use in CS requires further evaluation. This study aimed to assess the efficacy and safety of preoperative intravenous tranexamic acid in reducing blood loss during lower segment cesarean sections (LSCS).

Methods This prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary care hospital in Chennai, India, from December 2015 to November 2016. A total of 100 term women undergoing LSCS under spinal anaesthesia were randomly assigned to receive either 1 gm TXA (n=50) or placebo (30 ml 5% dextrose, n=50) intravenously 20 minutes before skin incision. Both groups received 10 IU oxytocin after delivery. The primary outcome was estimated blood loss (EBL) calculated from changes in haematocrit. Secondary outcomes included postoperative hemoglobin (Hb), packed cell volume (PCV), the need for additional uterotonics, maternal side effects, neonatal APGAR scores, and thromboembolic events up to 6 weeks postpartum.

Results The mean EBL was significantly lower in the TXA group compared to the placebo group (332. 62±172. 66 ml versus 413. 38±252. 21 ml; p=0.043). Postoperative Hb and PCV were preserved in the TXA group (with declines of 0.01 gm/dl and 0. 04%, respectively), whereas significant decreases occurred in the placebo group (declines of 1.00 gm/dl and 2.10%; p 1000 ml versus two (4%) in the placebo group. Additional uterotonics were needed in 6% (TXA) and 12% (placebo) (p=0.294). Maternal side effects were mild and similar between groups (8% each). No thromboembolic events were observed in either group. Neonatal APGAR scores and NICU admission rates were comparable.

Conclusions Preoperative intravenous tranexamic acid significantly reduces blood loss during and after caesarean section, with an excellent safety profile for both mother and neonate. Prophylactic TXA should be considered as a routine intervention in LSCS, particularly in settings where blood transfusion resources are limited.