Role of Tranexamic Acid Versus Uterine Cooling at Caesarean Section
Condition: Hemorrhage of Cesarean Section and/or Perineal Wound; Postpartum Hemorrhage; Uterine Atony
MeSH terms: Postpartum Hemorrhage; Uterine Inertia; Hemorrhage
Study type: Interventional
Phase: Phase 4

Summary: 
      This study aims to compare role of a prophylactic predefined intravenous Tranexamic Acid dose
      versus intraoperative Uterine Cooling in reducing blood loss and incidence of postpartum
      hemorrhage at secondary CS.
    

Detailed description: 
      Bleeding during vaginal or operative delivery is always of prime concern. Despite significant
      progress in obstetric care 125,000 women die from obstetric hemorrhage annually in the world.

      The incidence of CS is increasing, and the average blood loss during CS (1000 mL) is double
      the amount lost during vaginal delivery (500 mL). CS rate as high as 25-30% in many areas of
      the world. In Egypt the CS rate is 27.6 %, in United States of America, from 1970-2009 the CS
      rate rose from 4.5-32.9%, and declined to 32.8% of all deliveries at 2010. In spite of the
      various measures to prevent blood loss during and after CS, post-partum hemorrhage (PPH)
      continues to be the most common complication seen in almost 20% of the cases, and causes
      approximately 25% of maternal deaths worldwide, leading to increased maternal morbidity and
      mortality. Women who undergo a CS are much more likely to be delivered by a repeat operation
      in subsequent pregnancies. For women undergoing subsequent CS, the maternal risks are even
      greater like massive obstetric hemorrhage, hysterectomy, admission to an intensive care unit,
      or maternal death. Medications, such as oxytocin, misoprostol and prostaglandin F2α, have
      been used to control bleeding postoperatively.

      TXA is a synthetic analog of the amino acid lysine, as an antifibrinolytic agent. Its
      intravenous administration has been routinely used for many years to reduce or prevent
      excessive hemorrhage in various medical conditions or disorders (helping hemostasis), also
      during and after surgical procedures like benign hysterectomy, open heart surgeries,
      scoliosis surgery, oral surgery, liver surgeries, total hip or knee arthroplasty, and
      urology. It has been shown to be very useful and efficient in reducing blood loss and
      incidence of blood transfusion in these surgeries, and decreases the risk of death in
      bleeding trauma patients. It was also included in the World Health Organization (WHO) Model
      List of Essential Medicines.

      About its role in CS, some recent studies showed that TXA has advantage and useful effect
      safely in reducing blood loss and requirement of additional ecbolics. Its doses used
      intravenously to reduce blood loss at CS were a bolus of 1gm, 10 mg/kg , or 15 mg/kg which
      had an advantage over 10 mg/kg in anemic parturients.

      A recent study by Mitchell et al. concluded that Uterine cooling during cesarean delivery was
      efficient enough to decrease blood loss and the incidence of postpartum hemorrhage.

      This study aims to compare role of a prophylactic predefined intravenous Tranexamic Acid dose
      versus intraoperative Uterine Cooling in reducing blood loss and incidence of postpartum
      hemorrhage at secondary CS.
    

Intervention name(s): Tranexamic Acid; Intraoperative Uterine Cooling
Intervention type(s): Drug; Procedure
Intervention description(s): At 20 minutes preoperatively, TXA of 20 mg/kg was administered in Z Solution (500•0 ml normal saline containing a prophylactic antibiotic 1•0 g).; Intraoperatively immediately following delivery of the fetus the uterus was been externalized in the usual fashion, and the body of the uterus cephalad to the hysterotomy incision was been wrapped in sterile surgical towels saturated in sterile and iced normal saline. These towels came from a sterile cooling pot set to 30 degrees Fahrenheit. Iced saline-soaked towels was been kept in place for a minimum of 5 minutes and replaced at the discretion of the attending obstetrician until the hysterotomy is closed and the uterus is replaced into the patient's abdomen.
Other intervention name(s): TXA
Intervention MeSH terms: Tranexamic Acid
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Caesarean Section; Tranexamic Acid; Postpartum Hemorrhage; Ecbolics