The Efficacy of Parentral Tranexamic Acid in reducing Blood Loss in Normal Labour

INTRODUCTION: Child birth is one of the most cherished moment in a woman’s life. Labour natural is a unique experience and child birth is celebrated not only by the mother but by the entire family. Although the incidence of caesarean section is increasing throughout the world, the art of vaginal birth has not lost its charm. Birth is a life changing event. The care that ought to be given to a woman during labour has the potential to affect her both physically and emotionally in the short and long term. Though labour is a physiological process, it is often associated with morbidity and mortality. The most common cause of maternal mortality is blood loss. According to CEMACH Confidential enquiries into maternal and child health report life threatening obstetric hemorrhage occurs in approximately 3.7 per 1000 deliveries with uterine atony being the commonest cause. Management of PPH is the critical point in saving a mothers life. A lot of drugs are being used in management of PPH. The recent ones being the anti fibrinolytics and recombinant factor VIIa. AIM OF THE STUDY: 1. To evaluate the efficacy of parentral tranexamic acid in reducing blood loss during normal labour. 2. To compare it with amount of blood loss in patients who did not receive tranexamic acid in third stage. STUDY DESIGN: Prospective Randomised study, Placebo Controlled study. MATERIALS AND METHODS: Subjects of this prospective randomized placebo controlled study are 200 pregnant women admitted in labour ward of Government Theni Medical college. In all patients detailed history – Medical history, Obstetrics history will be taken. Vital parameters and basic investigations will be done. Weight of the patient will be noted. General examination, Obstetrics examination will be done. To confirm gestational age by USG. 100 patients will be placed in study group. 100 patients will be placed in control group.All patients will be counselled and inform consent will be obtained. Study group will receive injection oxytocin 10 units intramuscularly within one minute of delivery and injection Tranexamic acid 10mg/kg in 100ml normal saline over 20 minutes. Control group will receive injection oxytocin 10 units intramuscularly within one minute of delivery and placebo of 100ml normal saline over 20 minutes. INCLUSION CRITERIA: 1. Primi and second gravida, 2. More than 38 weeks of gestation, 3. Spontaneous /induced labour. EXCLUSION CRITERIA: Women with risk factors for PPH are not included in the study. 1. Haemoglobin less than 8gm, 2. Twin pregnancy, 3. Polyhydraminos, 4. EFW more than 4kg, 5. Previous history of PPH, 6. Fibroid complicating pregnancy, 7. Preeclampsia, 8. Prolonged and obstructed labour, 9. Heart disease complicating pregnancy, 11. Renal/ liver disease complicating pregnancy, 12. Patients on anticoagulants, 13. Previous history of thromboembolism, 14. Gravida more than or equal to three. METHODS: Both groups after receiving injections the following parameters will be noted. Predelivery BP, Pulse rate, respiratory rate, spo2, urine output, HB, PCV. Blood loss from delivery of the baby to two hours post partum will be noted. Side effects of the drugs will be noted. Post partum BP, Pulse rate, respiratory rate, spo2, urine output, Hb, PCV will be noted. Maternal needs for blood transfusion will be noted. Maternal outcome till discharge will be noted. SUMMARY: ◆ This study was conducted in the Department of Obstetrics and Gynaecology, THENI Government Medical college, THENI to clinically observe the blood loss reduced by tranexamic acid during normal labour. ◆ 200 patients were selected for the study, 100 as study group and 100 as Control group. ◆ 36% of the cases belonged to the age group 20 – 24 years. ◆ 49% of the cases belonged to class V socioeconomic status. ◆ 56% of the cases were primigravida and 44% of the cases were 2nd gravida. ◆ All the cases were booked cases. ◆ There was no statistically significant difference in the subjective characters in between the two groups. ◆ There was statistically no significant changes in blood pressure, PR, RR in the control group and the study group. ◆ Hb level and hematocrit was significantly reduced in the control group. ◆ compared to the study group. ◆ Tranexamic acid significantly reduced the blood loss from the time of delivery to 2 hour post partum. ◆ The need for additional uterotonics and maternal blood transfusion is significantly reduced in the study group compared to the control group. ◆ There was no side effects noted in the study group. ◆ The apgar scores and neonatal outcome was similar in both the groups. ◆ The duration of stay was found to be reduced in the study group when compared to the control group. CONCLUSION: Tranexamic acid injection, an antifibrinolytic agent when given prophylactically at the delivery of the anterior shoulder in 100 ml normal saline appears to reduce the blood loss during normal labour effectively. The need for blood transfusion is also reduced.