Comparative Study of Oxytocin Versus Tranexamic Acid and Ethamsylate for Reducing Blood Loss in Patient Undergoing Lower Segment Elective Cesarean Section at High Risk for Post-Partum Haemorrhage

Background: Worldwide, twenty-one per cent of deliveries are by elective cesarean Sections (C/S) as a lifesaving procedure to diminish maternal and neonatal mortality. Blood loss during C/S is more than that during vaginal delivery. Therefore, reducing blood loss during the C/S is essential and challenging for Anaesthesiologists. This study aimed to assess the efficacy of intravenous oxytocin and tranexamic acid + ethamsylate (TXA+Eth) in reducing blood loss in the elective lower segment (L/S) C/S in pregnant at high risk for postpartum haemorrhage (PPH). Methods: A single-centre, prospective, randomised, and double-blind study was started after obtaining institutional ethical approval among gravid undergoing elective L/S C/S at full-term pregnancy at high risk for PPH at the SAMSRI between September 2021 and March 2022. Study participants received an infusion of either oxytocin 10 International Unit (IU) or TXA 1 g + Eth 250 mg before the skin incision for C/S. The primary outcome was the blood loss calculation, along haemoglobin and haematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into PPH and required blood transfusion. Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly reduced bleeding during and after cesarean delivery in pregnant at high risk for PPH. In oxytocin and TXA + Eth groups, postoperative blood loss was (613.7 ±123.7 and 406.2±116.5) ml, respectively, p < 0.001. The duration of surgery (DOS) in oxytocin and TXA + Eth groups were (48.5±9.3) and (44.3±9.8) minutes, respectively (p= 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups were 10.69% and 0.75%, respectively (p= 0.023). The PPH in the oxytocin and TXA + Eth groups were 2.30% and 0%, respectively (p < 0.017). Pre and postoperative haemoglobin and haematocrit values at 12 hours after C/S in the oxytocin (10.78 and 8.29) and  (32.23+25.10) and TXA + Eth groups were (11.07 and 10.02) and (33.20 and 30.73), respectively (p < 0.001). Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss during C/S, the demand for blood transfusion, with the stability of haematologic profile during cesarean delivery.