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

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:

• Patients' postoperative 1st, 2nd, and 6th-hour vital signs (pulse rate, systolic and diastolic blood pressure, temperature, oxygen saturation).
• Shock indices.
• Hemogram and hematocrit values at 6-24 hours postoperatively.
• Duration of the surgery.
• Adverse effects experienced by the patients.
• Additional treatments administered.
• 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.

Inclusion criteria

• Patients aged 18-45 years
• gestational age between 37 and 41 weeks
• Perfomed ceserean section for delivery

Exclusion criteria

• did not provide informed consent,
• with comorbidities (such as heart, liver, or lung diseases),
• high-risk pregnancy (e.g., intrauterine growth restriction, cholestasis, preeclampsia, eclampsia, multiple pregnancies)
• known allergies to tranexamic acid or misoprostol
• known coagulation disorders