Intravenous Tranexamic Acid in Lower Segment Caesarean Section: A Randomized Controlled Trial on Blood Loss

Introduction: With the rising global incidence of Caesarean sections (CS), managing perioperative blood loss has become a critical concern. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing blood loss in various surgical procedures. This study evaluates the prophylactic role of TXA in reducing intraoperative and early postoperative blood loss during lower segment Caesarean section (LSCS). Material and Methods: A single-blind randomized controlled trial was conducted over 18 months at a tertiary care hospital in North India. Seventy term pregnant women undergoing elective or emergency LSCS were randomized into two groups. Group I received 1g intravenous TXA 30 minutes before skin incision, while Group II underwent standard management without TXA. Blood loss was measured intraoperatively and up to two hours postoperatively using both visual and objective methods. Hematocrit levels were assessed preoperatively and on postoperative Day 2. Data were analyzed using SPSS v20, with p<0.05 considered statistically significant. Results: Group I showed significantly lower intraoperative (306.03 ± 121.21 mL vs. 482.29 ± 162.41 mL) and total blood loss (355.46 ± 122.68 mL vs. 536.86 ± 162.89 mL) compared to Group II (p<0.001). The mean hematocrit drop was also lower in the TXA group (3.08% vs. 4.35%, p<0.001). No patient required blood transfusion or additional uterotonics. Conclusion: Prophylactic intravenous TXA significantly reduces perioperative blood loss and hematocrit decline during LSCS, supporting its safe and effective use in obstetric surgery.