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.