Reducing Blood Loss During Cesarean Myomectomy With Tranexamic Acid
Condition: Cesarean Section Complications
MeSH terms: Hemorrhage
Study type: Interventional

Summary: 
      This study was a double-blinded randomized controlled study conducted at Aswan University,
      Egypt from January 2018 to January 2020. Study inclusion criteria were women who attended the
      outpatient obstetric clinic, seeking antenatal care diagnosed with leiomyomas with pregnancy
      and with myoma staging from (3 to 6) according to FIGO staging. scheduled to undergo cesarean
      myomectomy (11) Exclusion criteria were: 1-Patients undergone vaginal delivery.2-Patients
      with a history of thromboembolic disease. 3-Cervical and broad ligament myoma. 4-Myoma FIGO
      staging
    

Detailed description: 
      Eligible participants were allocated to one of two groups after induction of anesthesia and
      immediately prior to the operation and just before skin incision. they received 1-gram
      tranexamic acid (10 ml) in 100 ml saline infusion or placebo (110 normal salines) by slow
      intravenous injection at an approximate rate of 1 mL per min. The abdomen was exposed through
      a midline or Pfannenstiel incision, after skin incision, the subcutaneous fat and abdominal
      fascia were opened crosswise, and the rectus muscle was opened on the midline. The parietal
      peritoneum was opened longitudinally to reach the pelvic cavity. Uterus was inspected for a
      number, location, and shape of myomas and other pelvic organs were inspected for associated
      pathology. a lower uterine incision will be performed to deliver the baby and Uterine
      incisions on top of myoma were performed. The incision was performed using monopolar
      diathermy. Intracapsular enucleation of myomas was performed by gently dissecting between the
      myoma and the pseudo-capsule. The myoma was grasped by Collins forceps and gently enucleated
      out.,. Myoma bed was closed by 1 or 2 layers of interrupted vicryl sutures (Vicryl 1-0
      polyglactin 910; Egycryl, Taisier CO, Egypt). At the end of the surgery, 1 intraperitoneal
      suction drain was routinely used in all patients the drains were removed on the second
      postoperative day unless otherwise indicated. Number and size of myomas were recorded. Myoma
      size represented the mean size of each myoma. Enucleated myomas were sent to histopathology.

      Blood loss estimation Intraoperative blood loss was measured by adding the volume of the
      contents of the suction bottle and the difference in weight (in grams) between the dry and
      the soaked operation sheets and towels (1 gram = 1 ml.). Post-operative blood loss was
      measured through intraperitoneal suction drain which measured every 12 hours and on removing
      the drain. After that, the total blood loss was calculated by the addition of intraoperative
      and postoperative blood loss.
    

Intervention name(s): IV tranexamic acid
Intervention type(s): Drug
Intervention description(s): in IV tranexamic acid group they received 1-gram tranexamic acid (10 ml) in 100 ml saline infusion or placebo (110 normal saline) by slow intravenous injection at an approximate rate of 1 mL per min.In topical tranexamic acid groupA gauze soaked with 2g tranexamic acid (20 ml) diluted in 100 ml of sodium chloride 0.9% or placebo (120ml of sodium chloride 0.9%.) used to compress the myoma bed for 5 minutes. To ensure a sufficiently high concentration, the tranexamic acid was diluted only to a volume sufficient to moisten a large wound surface. 20 ml moisten at least 1500 cm2.
Other intervention name(s): Topical tranexamic acid
Intervention MeSH terms: Tranexamic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: a double-blinded randomized placebo-controlled trial
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Cesarean Myomectomy; Tranexamic Acid