The Prophylactic Role of Tranexamic Acid in High Risk Pregnant Women Undergoing Elective Cesarean Section in Prevention of Postpartum Hemorrhage

All patients will undergo the following

I. History : Medical history, Obstetric history, Comorbidities, Allergies. II. Clinically: Vital signs, Abdomino-pelvic examination, per-vaginal examination.

III. Laboratory: Hemoglobin, Hematocrit before & after cesarean section. IV. Routine Ultrasound. V. Cesarean section: done under spinal anathesia.

VI. Calculation of blood loss:

The quantity of blood loss (ml) is calculated from 3 components :

• (weight of used towels during surgery - weight of used towels prior to surgery),plus
• (volume of blood sucked in suction container after placental delivery) ,plus
• (weight of used vaginal pad in the first 2 hours after CS - the pad' s dry weight)
• Each 1 mg increase the weight of either the towels or the vaginal pads is equivalent to 1 ml blood loss (Vitello, Dominic J., et al).

VII. Informed Consent: will be obtained from all participants including the pregnant women who are included in the study .

All patients will receive routine ecbolics ( oxytocin ) after delivery of baby.

Inclusion criteria

• High risk women undergoing elective C-section

• Hypertensive patients.
• Obese patients.
• Patients on LMWH.
• Transverse lie
• DM ( Type 1 & Gestational )
• Cardiac ( Not on Anticoagulants )
• Placenta Previa ( Not in PAS )
• Previous uterine scar ( > previous 2 C- section )

Exclusion criteria

• Patients with bleeding tendency.
• HELLP Syndrome.
• Emergency C- section.
• Mechanical prosthetic valve
• Atrial Fibrillation.
• Allery to tranexamic acid
• Placenta Accreta , Increta , percreata.