OPTIMIZATION OF PREVENTION IN ORDER TO REDUCE POSTPARTUM BLEEDING

Abstract

Introduction. According to the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan, in the structure of maternal mortality, postpartum haemorrhage (PPH) ranks third (5.5% in 2020). There are various approaches in the selection of dosage and the possibility of combining the most studied uterotonic oxytocin with other drugs for the prevention of PPH. Prophylactic use of tranexamic acid, a known antifibrinolytic, may reduce the risk of PPH. In the routine practice of an obstetrician-gynecologist, the issues of new effective approaches to the prevention of PPH are not updated, taking into account new data.
Clinicians around the world are expressing concern about the rising number of births by caesarean section and the potential negative consequences for maternal health. Tranexamic acid is recommended before surgery as a useful adjunct to oxytocin to reduce blood loss during abdominal delivery.
Purpose of the study. Efficacy of preoperative tranexamic acid administration in reducing blood loss during caesarean section in combination with optimal, controlled doses of oxytocin.
Material and methods. A randomized controlled trial was conducted among 244 women who delivered by caesarean section. The analysis was carried out using SPSS version 22. Study period: from January 2022 to June 2022. 244 participants, 122 in each, were divided into the main and control groups. Group A received 1 IU of oxytocin IV at a rate of 2.5–7.5 IU/h after delivery of the placenta along with 1 g of tranexamic acid IV during caesarean section 5–10 minutes before the skin incision, and group B received 10 IU of oxytocin IV according to the protocol for the diagnosis and treatment of PPH.
Results. The mean blood loss during caesarean section was 414 ml in the study group and 773 ml in the control group. The average postoperative hemoglobin was 101 g/l in the main group and 95 g/l in the control group. The mean postoperative hematocrit was 31.5% in the study group and 29.9% in the control group.
The discussion of the results. There were no significant differences between the two groups in terms of their overall characteristics, preoperative hematocrit and hemoglobin values, and operational characteristics in this study. Characteristics that could affect the amount of intraoperative blood loss were similar in both groups, and the observed differences in intraoperative blood loss were mainly due to the administration of a preoperative dose of tranexamic acid, as an additional agent to oxytocin in reducing blood loss during caesarean section in one group, since all patients in both groups received oxytocin after the birth of a newborn according to the protocol.
Conclusions. The reduction in blood loss was achieved by administration of a minimum dose of oxytocin 1 IU with the possibility of titration in combination with the administration of 1 gram of tranexamic acid as an adjunct to the uterotonic.