The adjunctive role of temporary uterine packing combined with topical tranexamic acid for reducing blood loss during hemorrhagic caesarean delivery: A randomized controlled trial


Objective. To explore the efficacy and safety of temporary uterine packing combined with topical tranexamic acid (TA) as an adjunct for reducing blood loss during a hemorrhagic cesarean delivery (CD), compared with placebo.
Materials and Methods. A prospective, open label randomized controlled trial was performed at an obstetrics and gynecology department of a tertiary university hospital, Egypt, between January 1, 2019, and July 1, 2023. Women were eligible if they were undergoing elective cesarean under spinal anesthesia and were bleed around 700ml by visual analog estimation and gravimetric measures. Participants were randomly assigned (1:1) to receive 400 μg misoprostol sublingually plus temporary uterine packing with topical tranexamic or matched placebo. the first outcome was the percentage of patients for whom hemorrhage was controlled with just the trial regimen.
Results. A total of 180 women fully completed the protocol (90 in each group). Extra needs of uterotonic or surgical procedures were performed in 26(28.9%) women within the TA group and in 59(65.6%) controls.  Blood loss between enrolment and 6 hours later was significantly lower within the TA group (1005.9 ± 141.3), than within the control group (1254.2 ± 228.5), (P = 0.001). Within the TA group, bleeding duration was shorter and progression to severe PPH and PRBC transfusion was less frequent than in controls (P < 0.01).
Conclusions. Uterine packing combined with topical tranexamic acid applied at the placenta bed, appeared to be more effectively reduce blood loss than did placebo during hemorrhagic CD.

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