الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Obstetric hemorrhage remains one of the major determinants of maternal death in both developed and developing countries. Because of its weight as a leading cause of maternal mortality and morbidity, obstetric hemorrhage (ante-partum and postpartum hemorrhages) must be investigated for national guideline development. Hemostatic drugs are not usually used as first-line treatment in postpartum hemorrhage (PPH). It was authenticated that extensive tissue injury can direct the hemostatic equilibrium toward increased fibrinolysis, leading to coagulopathy and bleeding. Antifibrinolytic drugs, namely tranexamic acid (TXA) have been recognized to decrease blood loss and transfusion needs in various elective surgeries. Furthermore, multiple studies concluded that tranexamic acid decreases the risk of death in bleeding trauma patients. Tranexamic acid decreases post-partum blood loss after vaginal birth and after cesarean section based on previous reports. Based on intensive research, the current literature is poor with studies handling the safety and efficacy of topical TXA in the decreasing intraoperative bleeding together with the prevention of postpartum hemorrhage. We aimed in our study to compare the hemostatic efficacy of hemostatic effect of local application of tranexamic acid on placental bed it is versus systemic injection to prevent the postpartum hemorrhage. This study was conducted at department of obstetrics and Gynecology of Tanta University Hospital on 100 pregnant cases. All the participant women were randomly classified into two equal groups each of (50) cases. group A (Intravenous tranexamic acid group): Include 50 patients were received 2g tranexamic acid diluted in 20ml normal saline administered intravenously over a 5-minute period at least 10 minutes prior to skin incision. group B (Topical tranexamic acid group): Include 50 patients were received 2gm tranexamic acid diluted in 100ml of normal saline distributed by strile syringe on placental bed after placental delivery. After delivery, both groups were receive a 5 IU intravenous bolus of oxytocin, and antibiotic was diluted in 20mL normal saline, and administered over a 5-minute period. Before operation, all subjects were subjected to complete history taking, detailed obstetric examination, and pelviabdominal ultrasound. Routine preoperative laboratory investigations were ordered as well. Cesarean section was performed in all cases using the standard procedure. Estimated blood loss along with operative time were recorded and tabulated in both groups.