Comparison of the Efficacy of Misoprostol and Tranexamic Acid for Postpartum Hemorrhage Prophylaxis in Cesarean Delivery

Overview

Postpartum hemorrhage (PPH) is an obstetric emergency, with an estimated incidence ranging from 2.8% to 7.9%. Recent studies indicate an increasing trend in the frequency of PPH.Although it is more commonly seen in developing countries, it remains a significant cause of maternal morbidity and mortality worldwide. Therefore, early diagnosis and prompt, accurate intervention are critically important. Despite the rising incidence of PPH, maternal mortality rates have declined. This improvement is largely attributed to better identification of risk factors, timely diagnosis, and effective intervention. To prevent PPH globally, active management of the third stage of labor has been widely implemented. This approach includes the use of pharmacologic agents, uterine massage, and controlled traction for placental delivery.Among pharmacological agents, the most commonly used include oxytocin, ergot alkaloids (e.g., ergometrine), tranexamic acid, prostaglandin E1 (misoprostol), prostaglandin F2α, and oxytocin analogues (e.g., carbetocin).Oxytocin is the most widely used agent for PPH prophylaxis. The aim of this study is to compare the efficacy of tranexamic acid and misoprostol in the prophylaxis of postpartum hemorrhage.

The study included emergency or elective cases scheduled for cesarean delivery at the Obstetrics and Gynecology Clinic, Maternity Ward of Etlik City Hospital, between December 2023 and December 2024. Patients were divided into three groups. Group 1 received tranexamic acid (Transamin 10% ampoule, 2.5 mL / 250 mg, Actavis Pharmaceuticals, Turkey); 1 gram was administered intravenously (I.V.) during the lower segment incision. Group 2 received misoprostol (Cytotec, 200 mcg tablet, Pfizer Incorporated company (Inc. , USA); 400 micrograms(mcg) were administered sublingually immediately after delivery of the baby and clamping of the umbilical cord. In addition, all patients received 20 International Units (IU) of oxytocin intramuscularly (I.M.) (Synpitan Forte, 5 IU/mL ampoule I.M./I.V., Deva Holding Inc. , Turkey). Despite the medical treatments administered, in cases where hemorrhage developed intraoperatively or postoperatively, additional interventions were performed, including medical (additional doses of oxytocin/tranexamic acid/misoprostol), mechanical (Bakri balloon), or surgical methods (uterine artery/hypogastric artery ligation, B-Lynch/Hayman sutures, postpartum hysterectomy). The parameters to be examined in the research are as follows: 1. Patients' postoperative 1st, 2nd, and 6th-hour vital signs (pulse rate, systolic and diastolic blood pressure, temperature, oxygen saturation). 2. Shock indices. 3. Hemogram and hematocrit values at 6-24 hours postoperatively. 4. Duration of the surgery. 5. Adverse effects experienced by the patients. 6. Additional treatments administered. 7. Whether blood transfusion was performed or not. In this study, the G-power analysis program was used to determine the minimum sample size, taking into account a 10% margin of error. According to the analysis results, the minimum number of patients to be included in the study for a total of 75 patients across 3 groups was determined. Statistical analysis of the data obtained in the study will be conducted using the Statistical Package for the Social Sciences (SPSS) version 22 software package. A 95% confidence interval will be calculated for each variable, and results will be considered statistically significant for p \< 0.05.