Blood Loss During Cesarean Delivery in Placenta Previa Patients
Placenta Previa
About this trial
This is an interventional prevention trial for Placenta Previa
Eligibility Criteria
Inclusion Criteria:
- Parity: primigravida or multigravida.
- Gestational age: ≥ 36 weeks (confirmed by the first day of the last menstrual period or first trimester ultrasound scan).
- Candidate for termination of pregnancy by cesarean delivery.
- Singleton living healthy normally growing fetus.
- Cesarean delivery under spinal anesthesia.
- Pregnancies complicated with placenta previa diagnosed preoperatively by ultrasonography (placenta previa was defined as placenta partially or totally covers the cervix)
Exclusion Criteria:
- Patients diagnosed with morbidly adherent placenta.
- Placenta previa cases requiring cesarean hysterectomy in the primary surgery.
- Patients with preoperative anemia (Hemoglobin <9 gm/dl).
- History of thromboembolic event.
- Known allergy to tranexamic acid or prostaglandins.
- Bronchial asthma or other contraindications of misoprostol.
- Patients with other risk factors of postpartum hemorrhage (e.g., polyhydramnios, fetal macrosomia, uterine fibroid).
- Patients known to have bleeding tendency (e.g., those receiving anticoagulation, patients with thrombocytopenia, factor VIII or IX deficiency or Von Willebrand's disease).
- More than 2 previous cesarean deliveries procedures.
- Prolonged procedure (more than 2 hours from skin incision to skin closure).
- Concomitant maternal medical disorders (either chronic or pregnancy induced)
Sites / Locations
- Kasralainy Cairo University
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Active Comparator
Active Comparator
Tranexamic acid group
Misoprostol group
Oxytocin only (control) group
Patients will receive 1 gm (10 ml) tranexamic acid diluted in 20 ml of Glucose 5% (administered as IV infusion over 5 minutes, at least 15 minutes prior to skin incision). Following the delivery of the baby, patients will additionally receive a slow IV bolus of 5 IU oxytocin and 20 IU oxytocin in 500 mL lactated Ringer's solution (infused at a rate of 125 mL/h).
Patients will receive 400 microgram misoprostol which will be inserted inside the uterus near the cornu after delivery of the placenta and swabbing the uterine cavity. Patients will additionally receive a slow IV bolus of 5 IU oxytocin and 20 IU oxytocin in 500 mL lactated Ringer's solution (infused at a rate of 125 mL/h).
Patients will receive only an IV bolus of 5 IU oxytocin and 20 IU oxytocin in 500 mL lactated Ringer's solution (infused at a rate of 125 mL/h) following the delivery of the baby.