Effect of prophylactic tranexamic acid on blood conservation in Indian women undergoing abdominal hysterectomy

Background: The prevalence of anemia in India is so high that majority of women presenting for hysterectomy are already with borderline hemoglobin status and the perioperative blood loss puts them at risk of death and prolongs recovery. Antifibrinolytic agents, mainly Tranexamic acid (TXA) have been demonstrated to reduce blood loss and transfusion requirements in various surgeries. The present study was done to assess the efficacy of TXA in effectively reducing intraoperative blood loss and the need for transfusion in Indian population undergoing abdominal hysterectomy for benign indications.Methods: This randomized, double-blind, placebo-controlled study was conducted on hundred patients undergoing abdominal hysterectomy. Group T (n = 50)- received TXA 15 mg/kg in 100 ml Normal saline and Group N (n = 50)-received the same volume of Normal saline infused over 15 minutes. Estimated blood loss need for blood transfusion, duration of surgery, postoperative hemoglobin and incidence of adverse events were noted.Results: There was statistically significant reduction in mean blood loss in group T when compared to group N (360 ml versus 540 ml). Accordingly, there was significant difference in the number of patients requiring blood transfusion (12% versus 42%) and also the postoperative hemoglobin levels. The group T patients had a significantly shorter operating time (127.86 versus 148.64 minutes). None of the patients developed any major adverse events.Conclusions: The prophylactic TXA safely and effectively reduces the blood loss and transfusion requirements in Indian patients undergoing abdominal hysterectomy for benign indications

Comparison of active versus expectant management on fetomaternal outcome in patients with placenta previa

Background: Placenta previa is one of the leading cause (31%) of obstetric hemorrhage. It accounts for significant maternal and perinatal morbidity and mortality. The objective of the present investigation was to compare the effect of active management versus expectant management on maternal and fetal outcome in patients with placenta previa.Methods: This randomized prospective cohort study was conducted on 100 Patients of 32 weeks to 36 weeks of gestation with diagnosis of Placenta previa. Selected patients were randomly divided into Group A- Active management and Group B - Expectant management.Results: In both the groups, majority of women were in the age group of 26-30 years and were multigravidas. The need for blood transfusion and the mode of delivery were similar in both the groups. Group A had higher incidence of PPH (22% vs 10%) and peripartum hysterectomy (18% vs 2%) when compared to group B. The maternal deaths were more in group A (4% vs 2%). Majority of the babies born to group A mothers had a low Apgar, birth weight below 2 kgs and greater NICU admission. The perinatal deaths were more in group A (16% vs 2%) and the difference was statistically significant.Conclusions: The expectant management protocol was concluded to be a better mode of management protocol in patients with placenta praevia, who are either asymptomatic or with mild to moderate bleeding

Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?

Background: Postpartum hemorrhage (PPH) accounts for 25% to 33% of obstetric deaths every year. Anemia is a cause and consequence of PPH. Despite intense efforts to prevent anemia, many Indian women labour with low hemoglobin levels. Tranexamic acid (TXA), an antifibrinolytic, have been demonstrated to reduce blood loss and transfusion requirements in various surgeries including cesarean section. Objectives were to study the efficacy of TXA in effectively reducing blood loss in Indian women following vaginal delivery.Methods: This randomized, double-blind, placebo-controlled study was conducted on 200 patients scheduled for vaginal delivery. In addition to oxytocin 10 units, group T received TXA 15 mg/kg and group P received normal saline administered over 5 minutes. Estimated blood loss, Hemoglobin deficit, need for additional uterotonics, need for blood transfusion, incidence of PPH and adverse events were noted.Results: The fall in hemoglobin was significantly higher in group P (p<0.00001). Estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P compared to group T (p<0.00001). The incidence of PPH was lower in group T (2.8% versus 11.3%). There were no significant difference in the need for supplementary uterotonics (9.9% versus 15.5%) and the incidence of blood transfusion (2.8% versus 8.5%). No adverse maternal and fetal outcomes were noted.Conclusions: To reduce blood loss following vaginal delivery, TXA may be safely recommended as standard adjunct to Oxytocin for regular management of third stage of labour, especially in developing countries like India

Cardiotocography in early labour: a screening test for predicting fetal outcome

Background: Fetal surveillance during labour is important to ensure delivery of a healthy baby with minimum intervention. Various parameters can be used to assess the fetal wellbeing like fetal movements perceived by the mother and monitoring of fetal heart rate. The objective of this study is to evaluate the efficacy of cardiotocography in early labour in predicting fetal outcome.Methods: A prospective hospital based cross sectional study was conducted on a total of 160 antenatal women in early labour with gestational age ≥ 37 weeks of gestation. Cardiotocogram was recorded for 20 minutes with the antenatal women in left lateral position. They are followed up till delivery and the mode of delivery of the baby was recorded. After delivery of the baby, the presence of fetal distress was assessed by careful examination of the neonate and colour of liquor.Results: Among the antenatal women, cardiotocography findings were normal in 74.4%, suspicious in 15% and pathological in 10.6%. The sensitivity of CTG in evaluating fetal outcome was found to be 84.6%, and the specificity was found to be 85.8%. The positive predictive value was 53.7% and the negative predictive value was 96.6%.Conclusions: Hence from the above study, it is can be concluded that the false positive rate of CTG is higher. Hence CTG cannot be used a sole indicator of fetal hypoxia. But in a resource limited setting, CTG is definitely a good screening test to predict the fetal outcome

A rare case of caesarean scar ectopic pregnancy: a case report

Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality