Carbetocin Versus Oral Tranexamic Acid Plus, Buccal Misoprostol on Blood Loss After Vaginal Delivery
Carbetocin Versus Oral Tranexamic Acid Plus, Buccal Misoprostol on Blood Loss After Vaginal Delivery
Excessive bleeding at or after childbirth accounts for about half of all the post-partum
 maternal deaths in developing countries and is the single most important cause of maternal
 mortality worldwide. Post-partum hemorrhage (PPH) is the major contributor to maternal
 mortality worldwide representing at least 25% of the maternal deaths annually. Prevention of
 PPH has become a global aim to reduce maternal mortality. Uterine atony is the main cause of
 PPH; therefore, active management of the third stage of labor has emerged as a most actual
 tool in its prevention. The previous study in Egypt recorded that 88% of deaths from PPH
 occur within 4 hours of delivery. Tranexamic acid (TA) is an antifibrinolytic agent that
 blocks the lysine-binding site of plasminogen to fibrin. Misoprostol is effective when given
 orally, buccal, sublingually, vaginally, or rectally, so it might be used by traditional
 birth attendants, or self-administered, in cases of home-births occurred without the
 attendance of health personnel or where women are at most risk for occurrence of severe PPH.
 So, the current study aims to evaluate the effect of prophylactic oral TA plus buccal
 misoprostol in the prevention of primary PPH after routine active management of the third
 stage of labor in women at low risk for uterine atony in comparison with carbetocin and
 buccal misoprostol alone.
All women admitted to the reception unit for vaginal delivery were invited to participate in
 the study. The investigators included women aged (20-35 years) with a singleton pregnancy in
 a cephalic presentation between 38 and 42 weeks gestation. The participated women have
 entered the screening phase of the study. This phase included history taking (age, parity,
 and gestational age) with measurement of weight, temperature, and initial hemoglobin level.
 The investigators excluded women with medical disorders such as cardiac, hepatic, renal,
 neurologic disorders thromboembolic disease, blood disorders, diabetes, gestational
 hypertension, and pre-eclampsia. Women at risk for PPH as grand multipara (parity >5),
 multiple pregnancies, polyhydramnios, fetal macrosomia, antepartum hemorrhage, prolonged, and
 obstructed labor were also excluded. Moreover, we excluded women with a scarred uterus or
 previous instrumental delivery and those suffering from hypersensitivity to TA. women were
 allocated to one of the three study groups: group I (carbetocin group) received 100 mc
 carbetocin IV after delivery of the baby, group II (misoprostol group) received 600 mg buccal
 misoprostol after delivery of the baby, and group III (TA plus misoprostol group) received
 1000mg oral TA at the end of the first stage of labor plus 600 mg buccal misoprostol after
 delivery of the baby. A buccal route, in which the tablets are placed in the cheek for 30 min
 after which any remnants are swallowed.
Inclusion Criteria:

 -  All women admitted to the reception unit for vaginal delivery

 -  women aged (20-35 years) with a singleton pregnancy in a cephalic presentation between
 38 and 42 weeks gestation.

 Exclusion Criteria:

 -  medical disorders such as cardiac, hepatic, renal, neurologic disorders thromboembolic
 disease, blood disorders, diabetes, gestational hypertension, and pre-eclampsia.

 -Women at risk for PPH as grand multipara (parity >5), multiple pregnancies,
 polyhydramnios, fetal macrosomia, antepartum hemorrhage, prolonged, and obstructed labor
 were also excluded.-

 -  Moreover, we excluded women with a scarred uterus or previous instrumental delivery
 and those suffering from hypersensitivity to TA.