Monika Ganpat Thavare ¹, Ajit Subhash Patil ¹

Affiliations
1 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Incidence of postpartum haemorrhage is 6.4% in caesarean section. WHO guidelines for prevention of PPH include oxytocin as first line drug. Intravenous tranexamic acid has been used to reduce hemorrhage during surgical procedures. In this study use of tranexamic acid on blood loss during and after Lower Segment Caesarean Section (LSCS) was evaluated. Aims and Objectives: 1. To study the efficacy of tranexamic acid in reducing blood loss during and after lower segment caesarean section, and 2. To study any side effect on neonate. Materials and Methods: A randomized prospective observational study of 100 patients were conducted. Patients were divided into: Group (A group) had received 1 gm tranexamic acid intravenous 20 minutes before skin incision + 20 units oxytocin drip in 500ml Ringer Lactate after delivery of baby. Group (B group) received only 20 units oxytocin drip in 500ml Ringer Lactate after delivery of baby. Patient’s blood loss was measured (intra operative, post placental and post-operative period) by weighing dry and soaked mops and separate suction bottle for blood. Results: Statistically significant difference (P < 0.001) in the quantity of blood loss was observed. In group A total blood loss during LSCS was 476.49 ml while in group B it was 576.06 ml. Intra operative blood loss in group A was 455.63 ml while in group B it was 536.53 ml. Post placental blood loss in group A was 411.59 ml while in group B was 485.08 ml. Not a single neonate had poor APGAR score and no NICU admission was required. Conclusion: Use of tranexamic acid with oxytocin significantly decreased blood loss during and after caesarean section without any side effect on neonate.

Keywords

Lower Segment Caesarean Section (LSCS), Oxytocin, Post-Partum Haemorrhage, Tranexamic Acid.

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Madhavi Anant Dasarwar ¹, Ajit Subhash Patil ²

Affiliations
1 PG Resident, Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Center, Nashik - 422003, Maharashtra, IN
2 Associate Professor, Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Center, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Pre-eclampsia is a pregnancy-specific syndrome recognised as a leading cause of maternal and perinatal mortality. Etiopathogenesis of preeclampsia is defective placentation and endothelial dysfunction leading to oxidative stress and cellular lysis. Lactate Dehydrogenase (LDH) is an intracellular enzyme of glycolysis. Hypoxia and cellular lysis results in elevated levels of LDH. Early detection and management are important in prevention of Preeclampsia complications and deaths. Hence, the present study was conducted to estimate levels of Sr. LDH in Pre-eclampsia patients to find its association with maternal and fetal outcome was undertaken. Materials and Methods: Present prospective study was conducted in Department of Obstetrics and Gynaecology from August 2016 to December 2018 consisting of 84 cases of preeclampsia of ≥28 weeks gestation divided in 2 groups; Mild and Severe Preeclampsia. Sr. LDH was estimated in all study participants and its association with parameters of maternal and fetal outcome was observed. Results: In the present study, 46 patients had Mild Preeclampsia. and 38 had Severe Preeclampsia. Most cases of Mild preeclampsia. i.e., 78.3% had LDH <600 IU/L whereas 71.1% of Severe Preeclampsia. had LDH >600 IU/L. Complications like eclampsia in 66.7%, HELLP in 33.3%, Abruptio placenta in 55.6%, ARF and DIC in 33.3% cases were noted more in patients with LDH >800 IU/L. Fetal still birth in 55.6%, Lower APGAR score and more NICU admission and Early neonatal death was present in babies of preeclampsia mother with LDH >800 IU/L. There was found statistically significant association (p<0.001) of raised Sr. LDH levels with poor maternal and fetal outcome in preeclampsia patients. Conclusion: Elevated levels of Sr. LDH during hypoxia, indicate the cellular damage and dysfunction occurring in preeclampsia. Detection of patients with increased levels of LDH is of crucial importance to detect and promptly manage the complicated cases and decrease the morbidity and mortality in mother and fetus.

Keywords

Fetal Outcome, Lactate Dehydrogenase, Maternal Outcome, Pre-Eclampsia.

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