الفهرس 
P OSTPARTUM H EMORRHAGE (Only 14 pages are availabe for public view
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Abstract
Background: Hemostatic disorders in the context of massive bleeding have long been deemed as coagulopathies resulting from blood loss, dilution and consumption, forming the “lethal triad” along with hypothermia and acidosis. More recent studies have shown, however, that shock and the resulting hypo perfusion may trigger coagulopathy independently of tissue trauma, with hyper fibrinolysis being regarded as the underlying mechanism.
Postpartum hemorrhage (PPH) is among the leading causes of maternal mortality worldwide. In a series of controlled studies on PPH in vaginal deliveries TXA proved capable of reducing the extent of peripartum bleeding and time to hemostasis.
Objective: to compare tranexamic acid plus oxytocin to oxytocin alone in their efficacy in reducing blood loss following CS.
Patients and Methods: This prospective double- blind randomized controlled clinical trial was conducted at the labor ward AinShams University Maternity Hospital. The study included 130 pregnant women scheduled for elective caesarean section who were randomly divided into two equal groups; group (A) recieved intravenous slow bolus of oxytocin 10 IU over 1 minute As soon as the umbilical cord is clamped while group (B) was received 1 gm tranexamic acid just before skin incision and intravenous slow bolus of oxytocin 10 IU over 1 minute .The amount of blood loss was evaluated in both groups. The operative time, number of patients requiring blood transfusion, surgical injuries during the procedure and maternal ICU admission were the secondary measures of outcome.
Results: Statistical analysis of our study showed that there were no significant differences between women of both groups regarding age, BMI, parity, gestational age, ABO & Rh blood groups, previous cesarean delivery, maternal and neonatal complications as blood transfusion and NICU admission, maternal side effects as nausea, vomiting, dizziness and diarrhea and postoperative hospital stay. Operative time was significantly shorter among tranexamic acid / oxytocin group. Amount of blood loss after CS was significantly lower in the tranexamic acid / oxytocin group. There was no significant difference between the studied groups regarding preoperative haemoglobin while postoperative hemoglobin was significantly higher in tranexamic acid / oxytocin group..
Conclusion: Using of tranexamic acid with oxytocin was more effective than oxytocin alone in reducing blood loss during and after cesarean section.