Prevention of cesarean postpartum hemorrhage with tranexamic acid. Bibliographical Review.

Abstract

Introduction: Postpartum hemorrhage (PPH), defined as blood loss of 500ml in vaginal delivery or 1000ml in cesarean delivery, is associated with alterations in uterine tone (atony), uteroplacental tissue retention, trauma or coagulation disorders, with uterine atony being the main cause. Conventionally, the administration of uterotonic agents during labor was established to prevent hemorrhage; however, nowadays, the dosage of ATX, an antifibrinolytic, is proposed for the prevention of PPH by cesarean section.

Objective: To analyze and establish the effectiveness of ATX for the prevention of PPH by cesarean section by means of a systematic review.

Methodology: A systematic review with retrospective descriptive design was performed based on literature in English and Spanish obtained from Pubmed, Google academic, The New England Journal of Medicine, Redalyc, ScienceDirect databases applying as exclusion criteria the last 5 years, from 2017 to 2022, low evidence and high bias. In addition, the administration of ATX exclusively for prevention of PPH by cesarean section was emphasized.

Results: The information gathered describes basic concepts of cesarean section and postpartum hemorrhage as well as the pharmacodynamics of ATX, allowing us to determine the efficacy of this antifibrinolytic in the prevention of PPH after cesarean section. In addition to the above, it allows us to determine the adverse effects and benefits of ATX administration.

Conclusions: Based on the information obtained, it was concluded that the administration of ATX (1 g or 10 mg/kg) is recommended for PPH prophylaxis after cesarean section, since it showed a reduction in preoperative and postoperative blood loss. It also reduced the need for blood transfusion, the decrease in the hemoglobin (Hb) and hematocrit (Hct) curves, the need for additional doses of additional uterotonic agents and the incidence of PPH in high-risk patients.