Bilateral uterine artery ligation plus intravenous tranexamic acid during cesarean delivery for placenta previa: a randomized double-blind controlled trial.

OBJECTIVE

To investigate the effect of adjunctive intravenous tranexamic acid (TA) on blood loss during cesarean section (CS) in patients with placenta previa undergone bilateral uterine arteryligation (BUAL).

METHODS

The study was double-blind randomized controlled trial carried out in a tertiary University Hospital between June 2016 to October 2017. We includedpatients scheduled for CS due to placenta previa. They were randomly allocated to group (I) managed by BUAL alone and group (II) managed by intravenous TA plus BUAL. The primary outcome was the amount of totalestimatedblood loss both intra- and post-operative.

RESULTS

Sixty-two patients were enrolled (n = 31 in each group). Patients received intravenous TA showed great reduction in total estimated blood loss compared with BUAL alone (p = .001). Additionally, the post-operative pulse was significantly higher in group (I) compared with group (II) (p = .002) and post-operative hemoglobin concentration was significantly lower in the same group compared with the other group (p = .034). More additional uterotonics was needed in group (I) than group (II) (29% vs. 3.2%, p = .006). Blood transfusion ≥4 units was required in 17 (54.8%) patients in group (I) versus 4 patients in group (II) (12.9%) (p = .0001). No difference between the study groups regarding the rate of cesarean hysterectomy (p = .27).

CONCLUSION

The adjunctive use of intravenousTA in patients undergone BUAL due to placenta previa is associated with decrease blood loss, need for additional uterotonics and blood transfusion during CS compared with BUAL alone.