EFFECTIVITY OF INTRAVENOUS TRANEXAMIC ACID IN ADDITION TO OXYTOCIN ON BLOOD LOSS DURING AND AFTER CAESAREAN DELIVERY"- A RCT.

Introduction: "The Reasons behind Mothers' Deaths" Maternal mortality linked to postpartum hemorrhage (PPH) increased dramatically between 2000 and 2002, from one incidence in 1997-1999 to ten instances in the most recent triennial. 2, 830 women perish per day from complications associated with pregnancy or delivery, according to WHO statistics. In 2015, there were an estimated 303000 maternal deaths worldwide, with PPH contributing to around 25% of these deaths. Aims: In order to minimize maternal mortality and morbidity from blood loss during cesarean birth, it is important to investigate the effectiveness of intravenous tranexamic acid administration in minimizing blood loss during and after the procedure. Methods: From January 2021 to June 2022, 100 women scheduled for elective cesarean birth at the Department of Obstetrics & Gynecology, Burdwan Medical College and Hospital, participated in a prospective, randomized, placebo-controlled trial. The study group, consisting of 50 participants, was administered 1 gram of intravenous tranexamic acid dissolved in a 20 milliliters solution of 5% Dextrose. The control group, also consisting of 50 participants, got an intravenous placebo, which was a 30 milliliters solution of 5% Dextrose. Tranexamic acid and a placebo were administered intravenously for a duration of 5 minutes, specifically 20 minutes prior to the initiation of spinal anaesthesia. Following delivery, 500 milliliters of normal saline were mixed with 10 units of oxytocin for each patient. Over the course of 20 to 30 minutes, an intravenous injection of oxytocin was given. Ten more oxytocin units were added to the intravenous fluid infusion that followed. Furthermore, for a full twelve hours following surgery, each patient received fifteen units of oxytocin, five of which were given to each intravenous fluid bottle for three consecutive bottles. The amount of blood lost during the procedure, the amount lost in the two hours after delivery, the total amount lost during the entire operation (including intra-operative and post-operative losses), and the difference in packed cell volume (PCV) values before and after the procedure were the main variables evaluated. Results: When compared to the control group, the study group showed substantially reduced amounts of intraoperative and postpartum blood loss. The trial group lost just 512.31 ± 60.16 mL and 65.94 ± 8.04 ml during the surgery and after delivery, compared to the control group's 731.42 ± 80.27 mL and 114.46 ± 15.65 mL, respectively. In all situations, these differences were statistically significant (P < 0.001), suggesting a substantial difference between the two groups. In comparison to the control group, the study group showed a significantly smaller difference in Packed Cell Volume values between the preoperative and postoperative phases (1.13 ± 0.48 versus 3.75 ± 1.16; P <0.001). In both groups, the average Apgar scores were comparable at 1 minute (6.56 ± 1.51 vs 6.37 ± 1.43, P=0.509) and 5 minutes (8.59 ± 0.99 vs 8.42 ± 1.17, P=0.243). Conclusion: Tranexamic acid lowers blood loss during and after lower segment caesarean sections considerably, without adversely affecting the health of the mother or the infant. [ABSTRACT FROM AUTHOR]