title: Role of Tranexamic Acid in Reducing Blood Loss in Vaginal Delivery.
abstract: BACKGROUND
  Anti-fibrinolytic agents are used to reduce obstetric blood loss as the fibrinolytic system is known to get activated after placental delivery.
  
  
  OBJECTIVE
  To evaluate the efficacy of parenteral tranexamic acid in reducing blood loss during normal labour and to compare it with the amount of blood loss in patients who received placebo in the third stage of labour.
  
  
  METHODS
  Patients with spontaneous labour or planned for induction of labour and fulfilling the inclusion criteria were recruited for the study. In each patient, the pre-delivery pulse rate, blood pressure, Hb gm% and PCV% were noted. Labour was monitored carefully using a partogram. The study group received Inj. Oxytocin and Inj. Tranexamic acid. The control group received Inj. Oxytocin and Placebo injection. Immediately after delivery of the baby, when all the liquor was drained, the patient was placed over a blood drape-a disposable conical, graduated plastic collection bag. The amount of blood collected in the blood drape was measured. Then the patient was given pre-weighed pads, which were weighed 2 h post-partum. The blood loss was measured by measuring the blood collected in the drape and by weighing the swabs before and after delivery.
  
  
  RESULTS
  The total number of patients studied was 100-equally distributed in both the groups. The age group of the patients and BMI were comparable. There was a significant increase in the pulse rate and decrease in blood pressure in the control group as compared with the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group as compared to the study group. The mean blood loss at the end of 2 h was 105 ml in the study group and 252 ml in the control group. There was a significant increase in the usage of uterotonics and also in the need for blood transfusion in the control group; 12 % of the patients in the control group had to stay for more than 3 days compared to 2 % in the study group.
  
  
  CONCLUSIONS
  Tranexamic acid injection, an antifibrinolytic agent when given prophylactically after the delivery of the baby, by intravenous route appears to reduce the blood loss and maternal morbidity during normal labour effectively.
authors.affiliation: Department of Obstetrics and Gynaecology, JSS Medical College and Hospital, Mysore, India.
authors.forename: Priyankur
authors.initials: P
authors.lastname: Roy
authors.affiliation: Department of OBG Unit - II, JSS Medical College and Hospital, JSS University, Mysore, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Sujatha
authors.affiliation: Department of OBG, JSS Medical College and Hospital, JSS University, Mysore, India.
authors.forename: Ambarisha
authors.initials: A
authors.lastname: Bhandiwad
authors.affiliation: Department of Obstetrics and Gynaecology, King's Mill Hospital, Sutton in Ashfield, Nottinghamshire UK.
authors.forename: Bivas
authors.initials: B
authors.lastname: Biswas
keywords: Blood loss; Maternal morbidity; Tranexamic acid