The effectiveness of uterine packing combined with topical tranexamic acid for the management of primary postpartum hemorrhage

Abstract

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary postpartum hemorrhage PPH compared to uterine packing alone. Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional local pathway of management of PPH had failed to control bleeding. In 15 women (the case group), uterine pack impregnated with 20 ml of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without tranexamic acid was used, outcome studied include the need for further surgical intervention and the need for blood product transfusion. Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference between effectiveness of each method is statistically insignificant. The requirement for blood product transfusion was less in TXA group. Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive surgical intervention as hysterectomy