Efficacy Of Combined Preoperative Sublingual Misoprostol And Intravenous Tranexamic Acid In Prevention Of Postpartum Haemorrhage During Elective Caesarean Section At A Tertiary Care Hospital In Central India: A Comparative Cross-Sectional Study

Introduction: Post Partum Haemorrhage (PPH) remains the leading cause of maternal mortality in India. Oxytocin alone may be inadequate in up to 40% of caesarean sections for prevention of PPH. This study evaluates a novel dual-mechanism approach using combined preoperative sublingual misoprostol and intravenous Tranexamic Acid in prevention of PPH during elective lower segment caesarean section (LSCS). Materials and Methods: A comparative study was conducted among 110 term women undergoing elective LSCS. The intervention group (n=55) received 600 micrograms sublingual misoprostol plus 1 g intravenous Tranexamic Acid, while controls (n=55) received standard care. Blood loss was measured by suction and gravimetric methods, and outcomes were analysed using t-tests and chi-square tests. Results: Both the groups were demographically comparable. Mean blood loss was significantly lower in the intervention group (681.8 ± 111.9 mL vs. 842.7 ± 118.0 mL, p<0.001). PPH incidence reduced from 12.7% to 1.8% (p=0.028). Fewer additional uterotonics (9.1% vs. 40%, p<0.001), blood transfusions (1.8% vs. 12.7%, p=0.028), and surgical interventions (7.3% vs. 23.6%, p=0.040) were required. Postoperative haemoglobin was better preserved (p=0.004). No primigravidae in the intervention group developed PPH. No major adverse events occurred. Conclusion: Combined preoperative sublingual misoprostol and intravenous Tranexamic Acid provides superior PPH prevention compared to standard care, with significant reductions across all measured outcomes. This cost-effective, thermostable, and easily administered dual-mechanism approach addresses both uterine atony and enhanced fibrinolysis, making it particularly suitable for resource-limited settings where maternal mortality from PPH remains high.