Tranexamic acid administration; which is effective preoperative versus intraoperative in reducing blood loss during cesarean section

Background: Cesarean section (CS) is frequently performed in Egypt. However, it may be associated with significant blood loss, which carries a substantial risk for perioperative morbidity and mortality. Tranexamic acid is known for its hemostatic effects in multiple gynecological and obstetric procedures, including CS. That drug inhibits the conversion of plasminogen into plasmin. Nonetheless, the proper timing of its administration is not clearly elucidated. Objectives: We compared preoperative (PrO) versus intraoperative (IO) administration of tranexamic acid regarding blood loss during CS. Patients and methods: We included 106 pregnant ladies in our prospective randomized trial, who were divided into two equal groups. Intraoperative blood loss was calculated, along with changes in hemodynamics, hemoglobin, and the hematocrit value. Results: Intraoperative blood loss showed a significant decline (p ˂ 0.001) in the PrO group (596.23 mL, compared to 674.53 mL in the IO group). Both study groups expressed no significant difference regarding their preoperative hemoglobin and hematocrit values. However, postoperative laboratory assessment revealed a significant reduction (p ˂ 0.001) of both parameters in the IO group (hemoglobin decreased from 11.9 to 10.68 gm/dl whereas hematocrit decreased from 36.05% to 32.02%). The same group expressed a significant increase in heart rate and a significant decline in mean arterial pressure 30 minutes after the procedure, and these changes persisted till the end of the recordings (p ˂ 0.001). Conclusion: The preoperative tranexamic acid administration is superior to its intraoperative administration, as it leads to less blood loss, hemoglobin changes, and a relatively better hemodynamic profile.