COMPARISON BETWEEN TRANEXAMIC ACID AND MISOPROSTOL FOR THE PREVENTION OF HEMORRHAGE FOLLOWING CESAREAN DELIVERY

Sulaiman Samir Jolak*, PhD. Louai Hasan and PhD. Maisoon Dayoub

ABSTRACT

Background: Cesarean section (Cs) is the most common major surgical procedure performed on females worldwide, and it is the main cause of the rising numbers of deaths due to cesarean-related hemorrhage. Despite the advances in the medical field, obstetric hemorrhage remains a well-recognized complication of childbirth in both developed and developing countries. Objective: this study compares the effectiveness of administering sublingual Misoprostol combined with oxytocin to that of IV Tranexamic acid combined with oxytocin to reduce intra and post-operative blood loss. Materials and Methods: This prospective randomized clinical trial was performed in Tishreen university hospital, Syria, between 2024 and 2025. A total of 150 pregnant women aged 19-40 years with a gestational age of 37-40 weeks were included and assigned into Two groups (n=75 in each group): Group A received Tranexamic acid, ten minutes before the skin incision, one ampoule (1 g) was injected. group B received Misoprostol, immediately after the delivery two sublingual pills (400 mg) were administrated. In both groups, immediately after the delivery 20 units of oxytocin was injected. After the operation, the Cs duration was recorded, the amount of bleeding was measured based on the number and differences in weight of the mops before and after the procedure, the blood in the suction container excluding the amniotic fluid, and the difference of patient’s hemoglobin before and 24 h after surgery. Need for added uterotonics, need of blood transfusion, and adverse effects of drugs was also assessed. Results: The preoperative and postoperative hemoglobin in Tranexamic group were identified as 12.59±0.8, 11.19±0.7 respectively, whereas it was identified as 12.81±0.5, 10.35±0.2 respectively in Misoprostol group. Hemoglobin level reduction in the Misoprostol group was higher than the Tranexamic group - 2.46 ± 0.4 vs - 1.4 ± 0.2. The mops weight and count were recorded higher in Misoprostol group compared to Tranexamic acid group 271.11±84.7 vs 214.22±91.6 and 4.19±2.1 vs 3.42±1.1 respectively. blood suction in the Misoprostol group was significantly higher compared to Tranexamic acid group 258.82 ± 77.6 vs 206.19 ± 84.2 respectively. The common side effects identified in the Misoprostol group was chills and fever 13.3%, and 10.7% respectively. while, it was 2.7%, and 2.7% respectively in the Tranexamic acid group. Conclusion: In clinical practice, both Tranexamic acid and Misoprostol are effective in reducing blood loss during and after cesarean section; But Tranexamic acid was better as there were significantly lesser blood loss and fewer side effects especially in uncomplicated cases.

Keywords: Postpartum hemorrhage, Cesarean Section, Tranexamic Acid, Misoprostol, Blood loss.