DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222802
Published: 2022-10-28

Effect of prophylactic tranexamic acid in normal vaginal delivery

Vishakha Gupta, Alka Sehgal, Rimpy Tandon, Dilpreet Kaur Pandher, Anita Tahlan

Abstract


Background: Use of tranexamic acid (TXA) in combination with uterotonics in management of postpartum haemorrhage is quite established, but its use for prophylaxis is still uncommon, specifically post normal delivery. Shock index (SI) (heart rate divided by systolic blood pressure) and delta shock index (DSI) i.e., difference of SI before and after an event are being recognized as tools for hemodynamic status evaluation and bedside assessment for individual respectively. The present study compared the combined effect of TXA and oxytocin uterotonic on postpartum blood loss as evaluated by shock index (SI) and delta shock index (DSI) in low-risk pregnancies.

Methods: 230 subjects divided equally, underwent randomised control trial with combination of Injection TXA and oxytocin versus oxytocin alone immediately post-delivery and impact evaluated using SI, DSI, postpartum haemoglobin (HB) and haematocrit (HCT) at admission and one hour postpartum, followed for six weeks for any complications.

Results: Prophylactic use of TXA in terms of SI values, HB and HCT revealed significant improvement, in both preterm and term pregnancies with either spontaneous or induced labours. DSI with a sensitivity of 69.6% and specificity of 67% with a simple plus or minus notation gave a satisfactory idea of shift of stability and instability of hemodynamic status of an individual as an indirect predictor of blood loss with a cut-off between -0.0682 to +0.1182. 6 weeks postpartum follow up was uneventful.

Conclusions: The study depicted benefit and safety profile of prophylactic use of TXA in low-risk pregnancies, significant for developing countries with high incidence of anaemia during pregnancy and advocates incorporation of SI and DSI as markers of haemodynamic status in partograph.


Keywords


Postpartum haemorrhage, Pregnancy, Shock, Tranexamic acid

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References


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