Abstract
Author(s): Khaled M. Alanwer*, Nehal Bassiouny, Mohamed Abdo, Mohamed Alshahat Elsayed Ali, Mohamed Mohamed Hegab, Bahaa G Mohamed
Background and aim: Prophylactic Tranexamic acid (TxA) shows promise in reducing postpartum hemorrhage. This study aimed to evaluate the effectiveness of routine prophylactic TxA in reducing blood loss during elective Cesarean Sections (CS) at a tertiary care center. Methods: This retrospective cohort study was conducted at Saudi German Hospital from May 2018 to April 2022, approved by ERC (004/2022). It included 600 women undergoing elective CS, divided into two groups: a TxA group (n=300, May 2020–April 2022) receiving 1g IV TxA and a control group (n=300, May 2018–April 2020) receiving none. The primary outcome was hemoglobin drop ≥ 2 g/dL. Secondary outcomes included estimated blood loss (EBL) and neonatal parameters. Statistical analysis utilized t-tests, chi-square, and multivariable regression. Results: Baseline characteristics were comparable. The TxA group demonstrated a significantly lower mean Hb drop (1.0 ± 0.9 g/dL vs. 1.8 ± 1.1 g/dL, p<0.001) and reduced mean EBL (685 ± 155 mL vs. 745 ± 165 mL, p<0.001) compared to controls. The incidence of Hb drop ≥ 2 g/dL was significantly lower in the TxA group (14.9% vs. 30%, p<0.001). Rates of blood transfusion, hysterectomy, ICU admission, and prolonged hospital stay were not significantly different. Neonatal outcomes (APGAR scores, umbilical pH) were marginally better but statistically nonsignificant in the TxA group. Conclusion: Prophylactic tranexamic acid significantly reduces intraoperative blood loss and hemoglobin decline in elective cesarean sections without increasing adverse maternal or neonatal outcomes.