Comparison of the Effect of Tranexamic Acid and Misoprostol on Blood Loss During and After Cesarean Section: A Randomized Clinical Trial

Document Type : Original Article


1 Research Assistant, ENT-HNS Research Center,Hazrat-e- Rasool Hospital,Iran University of Medical Sciences, Tehran,Iran

2 Assistant professor of obstructs and gynecology, Bandar abas Medical University of Medical Science,Hormozgan,Iran

3 Resident of gynecology and obstetrics, Bandar abas Medical University of Medical Science,Hormozgan,Iran


Background: One proposed methods to reduce the amount of bleeding during and after cesarean section, is the use of drugs such as Tranexamic acid and Misoprostol.This study aimed to compare the effect of Tranexamicacid and Misoprostol on bloodloss during and after cesarean section. Methods: This is a randomized clinicaltrial performed in Shariati and Khalij-e-Fars Hospitals of Bandar Abbas, Hormozgan, during 2015-2016. The study population included all candidates for cesarean section. 300 pregnant women aged 18-40 years with gestational age of 37-42 weeks were included, divided into three groups each: A received tranexamic acid,B, misoprostol, and C, 200 cc normal saline. During C/S , all patients received 20 and 30 units of oxytocin, respectively. The level of blood loss during the operation was determined by measuring the total blood volume suctioned after removing the placenta and the difference in the weight of bloody sterile pads and surgical sheets before and after the operation. Results: Preoperative hemoglobin level was 11.96±1mg/dl in the groupA,11.62±1.21mg/dl in the groupB, and 12.28±1.26mg/dl in the placebo group, which was statistically significant (P=0.001). Postoperative hemoglobin level was reduced about 1.02±0.35(10.9 ±0.99mg/dl) in the groupA, 1.19±0.52(10.46±1.04mg/dl) in the groupB, and 1.36±0.50(10.93±1.34mg/dl) in the placebo group. There was a significant difference between the three groups in the volume of bloodloss during the operation and the first two hours after the operation(P



    1. Palley M. The Politics of Women’s Health Care in the United States. Springer; 2014 Feb 24.
    2. AbouZahr C. Global burden of maternal death and disability. British medical bulletin. 2003 Dec 1;67(1):1-1.
    3. Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. International Journal of Gynecology & Obstetrics. 2011 Dec 31;115(3):224-6.
    4. Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodónico L, Bataglia V, Faundes A, Langer A. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. The Lancet. 2006 Jun 9;367(9525):1819-29.
    5. Lapaire O, Schneider MC, Stotz M, Surbek DV, Holzgreve W, Hoesli IM. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. International Journal of Gynecology & Obstetrics. 2006 Oct 1;95(1):2-7.
    6. Sood AK, Singh S. Sublingual misoprostol to reduce blood loss at cesarean delivery. The Journal of Obstetrics and Gynecology of India. 2012 Apr 1;62(2):162-7.
    7. Brown RS, Thwaites BK, Mongan PD. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass operations: a double-blind, randomized, placebo-controlled trial. Anesthesia & Analgesia. 1997 Nov 1;85(5):963-70.
    8. Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, Hayashi R, Kuriyama S. Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties. Archives of orthopaedic and trauma surgery. 2000 Aug 8;120(9):518-20.
    9. Dunn CJ, Goa KL. Tranexamic acid. Drugs. 1999 Jun 1;57(6):1005-32.
    10. Waterstone M, Murphy JD, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control studyCommentary: Obstetric morbidity data and the need to evaluate thromboembolic disease. Bmj. 2001 May 5;322(7294):1089-94.
    11. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The lancet. 2010 May 14;375(9726):1609-23.
    12. Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2003;1.
    13. Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. The Lancet. 2006 Oct 13;368(9543):1248-53.
    14. Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk OC, Sudolmus S, Ark C. Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study. American journal of perinatology. 2011 Mar;28(03):233-40.
    15. Williams-Johnson JA, McDonald AH, Strachan GG, Williams EW. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. West Indian Medical Journal. 2010 Dec;59(6):612-24.
    16. Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ. Patterns and predictors of severe postpartum anemia after Cesarean section. Transfusion. 2017 Jan 1;57(1):36-44.
    17. Saghaei M. Random allocation software for parallel group randomized trials. BMC medical research methodology. 2004 Nov 9;4(1):26.
    18. Robinson N, Kapungu C, Carnahan L, Geller S. Recommendations for scale‐up of community‐based misoprostol distribution programs. International Journal of Gynecology & Obstetrics. 2014 Jun 1;125(3):285-8.
    19. Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol. Anesthesiology Clinics. 2017 Mar 30.
    20. Zavoshti FR, Andrews FM. Therapeutics for Equine Gastric Ulcer Syndrome. Veterinary Clinics of North America: Equine Practice. 2017 Apr 30;33(1):141-62.
    21. Lanas A, Chan FK. Peptic ulcer disease. The Lancet. 2017 Feb 25.
    22. Aung HH, Soe A, Aye NN. Effect of misoprostol on the pharmacokinetics of sustained release diclofenac in Myanmar healthy male volunteers. Siriraj Medical Journal. 2017 Mar 24;69(2):75-9.
    23. Acharya G, Al‐Sammarai MT, Patel N, Al‐Habib A, Kiserud T. A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra‐operative blood loss during cesarean section. Acta obstetricia et gynecologica Scandinavica. 2001 Mar 1;80(3):245-50.
    24. Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2004 Feb 10;112(2):154-7.
    25. Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. American journal of obstetrics and gynecology. 2008 Jul 31;199(1):36-e1.