will be averse to taking medications. The good news is that, in addition to counseling mentioned previously, there is good evidence that acupuncture works to reduce depressive symptoms during pregnancy (Obstet Gynecol 2010;115: 511-520). Certainly, that would be a great first-or secondline therapy in patients disinclined toward antidepressant medications.-ABC)
ABSTRACTWomen are at risk of blood loss during cesarean delivery (CD), because of increased fibrinolysis from tissue injury. Recently, tranexamic acid (TA), a potent antifibrinolytic agent that functions by inhibiting lysine-binding sites, has emerged as a potential prophylactic therapy for women in this position. Consequently, the authors of the present study assess the potential efficacy of TA administration for women undergoing CD.In this prospective randomized unblinded clinical trial, 124 women with singleton pregnancies undergoing elective CD (previous CD, abnormal presentation, maternal request, previous repair of cystocele, and/or perineal tear) were randomized into 2 groups. Five minutes prior to the start of CD, patients in the study group received a TA dosage of 10 mg/kg per body weight intravenously over 5 minutes. Patient vital signs data were collected, and patients were monitored per standard protocol for adverse events until discharge (3 days after surgery), as TA may affect renal function, then followed up at 1 week after the operation. To estimate blood loss amounts, surgical drapes, swabs, and pads used from CD start (skin incision) up to 2 hours postpartum were weighed prior to usage (dry) and then after usage (wet).Patients who received TA had significantly less blood loss (30% less, 391 vs 597 mL) than did patients who did not receive TA (P < 0.001). In addition, the authors found that history of previous CD was an indicator for increased risk of blood loss during surgery, possibly due to placental scarring, and that TA significantly reduced this risk. No postpartum hemorrhage was observed during or immediately after surgery, although 3 patients in the control group needed blood transfusion 12 to 18 hours after delivery. This may relate to postoperative hemoglobin, hematocrit values being significantly higher in TA patients than in control patients (10.3 g/dL, 36.2% vs 9.2 g/dL, 34.5%; P < 0.05). Lastly, tolerable adverse effects, mainly gastrointestinal upset, were observed in TA patients.The results of this study support previous findings. Administration of TA prior to the start of CD can significantly help to decrease blood loss during and after surgery, especially in women with history of previous CD, placenta previa, twin pregnancy, and so on. However, authors note that caution should be used when administering TA to patients with renal impairment, as TA is known to affect renal function.
