Prophylactic effect of misoprostol versus tranexamic acid in conjunction with oxytocin in reduction of post-partum hemorrhage after cesarean sectionin: A randomized clinical trial

Abstract

Introduction: Postpartum hemorrhage is an important complication and is a direct cause of maternal death and its effective prevention has a significant role in reducing complications, especially maternal mortality. In this way, the purpose of this study was to compare the prophylactic effect of the addition of misoprostol and transxamic acid to oxytocin in reducing postpartum hemorrhage after cesarean section. Materials and Methods: In a clinical trial, 285 pregnant women with gestational age of 38 to 39 weeks candidates for elective cesarean section enrolled in the study and were randomly assigned to three groups. After spinal anesthesia and cesarean section, immediately after clamping of the umbilical cord, patients in the first group received misoprostol 400 mcg rectal, patients in the second group received 10 mg/Kg tranexamic acid by intravenous infusion. First and second groups (as intervention groups) and third one (as control group) all received 30 units oxytocin during operation and 60 units within 12 hours after the section. Counting the gases was performed after the operation and measuring hematocrit levels 24 hours later. Results: The mean± SD of age was 29.72 ± 3.8 years and was not significantly different in the three groups (P = 0.171) and 246 participants (84.4%) came for their second parity. The studied groups did not differ in parity number (p = 0.170). The average number of consumpted gauzes was 6.99. Three groups were different in terms of consumpted gauzes during section (p < 0.001). Mean of hematocrit before and after intervention showed significant differences in the three groups (p < 0.001). Intervention groups have a better effect on bleeding compared to control one in terms of hematocrit changes (p < 0.001), however, two misoprostol and tranexamic acid drugs showed no difference in reducing it (p = 0.117). Conclusion: Adding each of the misoprostol or tranzamic acid to oxytocin alone has a better effect in reducing bleeding alone, but since the therapeutic effects of these two drugs are similar, it is necessary to select the drug according to the patient;#39s clinical condition and possible side effects of either drug