Human Placental Transfer of an Antifibrinolytic Agent (AMCA)

Abstract

A fibrinolytic inhibitor AMCA (trans p-aminomethyl cyclohexane carboxylic acid) was given i.v. in a dose of 0.01 g/kg bodyweight to 12 mothers about to be delivered by Caesarean section. Immediately after delivery the concentration of AMCA was determined in the maternal blood and in cord blood. AMCA was determined by a chemical method based on high voltage paper electrophoresis and photometric determination of the ninhydrin complex. It was found that AMCA passes through the placenta and that the concentration of the drug in the cord blood can be fairly high (4-31 ,ug per ml). The possible value of prophylaxis of the foetus with AMCA by the maternal route to check fibrinolytic bleedings (pulmonary or intracranial) sustained during premature delivery is discussed.

Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum

“…Similarly, tranexamic acid has also been used for women with antepartum hemorrhage due to placenta abruption or placenta previa [14,15,17,20]. Placental abruption is characterized by activation of the fibrinolytic system [14], and tranexamic acid can offer local hemostasis and reduce risk of premature labor [4]. Asted et al [38] reported the first case of placental abruption at 26 weeks of gestation managed successfully with tranexamic acid.…”

“…Tranexamic acid crosses the placenta. However, its lack of effect on plasminogen activator activity in the vascular cell wall protects the fetus and newborn from potential thromboembolic complications [4]. Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality throughout the world.…”

International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency

“…118,119 However, studies of the teratogenic risk in human subjects have not yet been performed. Doses of TA, similar to those of patients with HAE-C1-INH, have been administered during pregnancy for other diseases but for a much shorter period of time.…”

The safety of treatments for angioedema with hereditary C1 inhibitor deficiency

“…Although TA crosses the placenta [103], no teratogenic activity or harmful fetal effects have been reported so far both in case reports and in animal studies. However, TA should not be administered during breast-feeding.…”