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Subject Area

Ophthalmology

Article Type

Original Study

Abstract

Objective To compare the efficacy of using misoprostol alone or in combination with tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). Background Normal blood loss during labor is ∼300–400 ml. Blood loss more than 500 ml following vaginal birth or greater than 1000 ml following CS means postpartum hemorrhage. Patients and methods A prospective randomized comparative clinical study was conducted on 150 patients who were divided into two groups: group A (75 patients) received misoprostal 600 mcg rectally before the incision, and group B (75 patients) received misoprostal 600 mcg rectally and 1-g TA slowly intravenously 10 min before the incision. Full medical history, physical examination (general condition and vital signs), prothrombin time, liver and kidney functions, and blood loss volume were recorded. Results Mean age of the studied patients was 28.32 ± 4.65 years in group A and 27.81 ± 5.07 years in group B. Moreover, there was a statistically significant difference between groups regarding hemoglobin postoperatively (P = 0.038), hematocrit postoperatively (P = 0.033), systolic (P = 0.043) and diastolic (P = 0.037) blood pressures 2 h postoperatively, heart rate 2 h postoperatively (P = 0.045), blood loss in the first (P < 0.001) and second periods (P = 0.019), and total blood loss (P < 0.001), with a difference of 146.15 ml (22.6%) less blood loss observed in group B than group A. Conclusion The use of TA before CS is significantly effective in reducing blood loss during cesarean birth, with no observed maternal or neonatal adverse effects (in addition to its low cost). Misoprostol in combination with TA is the most effective treatment in decreasing the amount of blood loss during CS.

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