The effect of tranexamic acid in cesarean section surgery of pregnant women with high risk of postpartum hemorrhage

Postpartum hemorrhage continues to be a life-threatening complication in cesarean deliveries. Although the use of tranexamic acid is routinely recommended for the treatment of postpartum hemorrhage, there is no clear evidence for its prophylactic use. In this study, we aimed to observe the estimated blood loss, incidence of postpartum hemorrhage, and transfusion requirements of patients at high risk for postpartum hemorrhage who underwent elective cesarean section, focusing on the effect of tranexamic acid. After obtaining ethical approval and patient consent, a total of 83 patients between the ages of 20 and 41 years old with high risk of postpartum hemorrhage (multiple pregnancies, previous history of cesarean section, pregnancy-induced hypertension, macrosomia, history of postpartum hemorrhage, cesarean section during delivery, anemia, placenta previa, placental invasion anomalies) and ASA II physical status were included in the study. Four groups with controls were formed to examine the effect of tranexamic acid in both general anesthesia and spinal anesthesia. In the study groups, 1 gram of tranexamic acid was administered intravenously after clamping the cord, and estimated blood loss was calculated using a formula. Additionally, the patient's transfusion requirements, the incidence of postpartum hemorrhage, changes in hemoglobin and hematocrit levels, side effects of tranexamic acid and use of uterotonics were noted. In our study, the estimated blood loss was calculated as 511 ml in Group 1 and 579 ml in Group 3 from the tranexamic acid groups, and 590 ml in Group 2 and 617 ml in Group 4 from the control groups. There were no significant differences among the groups in terms of estimated blood loss, transfusion requirements, and incidence of postpartum hemorrhage (p>0,05). When secondary outcomes were examined, there were no differences among the groups in terms of postoperative changes in hemoglobin and hematocrit levels, side effects and use of uterotonics (p>0,05). No thromboembolic events were observed in any of the patients who received tranexamic acid. In conclusion, it was determined that the prophylactic use of tranexamic acid was not effective in reducing blood loss and transfusion requirements in both general anesthesia and spinal anesthesia during cesarean operations