Efficacy of Tranexamic Acid Injection With Oxytocin in Preventing Bleeding During and After Elective Cesarean Section: A Randomized Controlled Trial

Objectives: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. The present study aimed to investigate the effect of tranexamic acid (TXA) injection with oxytocin verses oxytocin alone in preventing bleeding during and after elective cesarean section. Materials and Methods: This randomized, double-blind, placebo-controlled clinical trial enrolled 200 full-term, singleton pregnant women candidates for elective cesarean section. Patients were randomly assigned to either an intervention group (n=100) or a control group (n=100). The intervention group received 1 gram of TXA administered intravenously 20 minutes before skin incision. The control group received an identical volume of placebo (0.9% saline). Both groups subsequently received 30 units of oxytocin in 500 mL of Ringer’s lactate solution after umbilical cord clamping. Primary outcomes were intraoperative and postoperative blood loss. Secondary outcomes included the need for additional uterotonics, changes in hemoglobin levels, and the incidence of adverse effects. Results: The study found no significant differences between groups in terms of maternal age, gestational age, parity, gravidity, body mass index, and infant weight. The mean intraoperative blood loss was 466.0 ± 110.5 ml in the intervention group and 491.1 ± 102.1 mL in the control group (P=0.18). The mean postoperative blood loss was 505.7 ± 113.1 ml and 507.1 ± 77.3 ml, respectively (P=0.81). There were no significant differences in pre- and post-operative hemoglobin levels, need for additional uterotonics, or other hematologic indices. While 9 patients (9%) in the intervention group and 4 patients (4%) in the control group reported side effects such as nausea and vomiting, this difference was not statistically significant (P=0.15). Conclusions: The findings suggest that intravenous administration of 1 gram of TXA before cesarean section along with oxytocin does not reduce bleeding during and after elective cesarean section in low-risk women. Therefore, its routine use is not recommended for this population.