Oral Tranexamic Acid versus Intravenous Tranexamic Acid in Reducing Intraoperative Blood Loss during Elective Cesarean Section_

Abstract

Background: The cesarean section (CS) rate globally is rising, particularly in Egypt, where it increased from 20% in 2005 to 52% in 2014. While CS can be lifesaving in com-plicated deliveries, it poses risks such as excessive blood loss and complications in future pregnancies. Obstetric hemorrhage accounts for 27% of maternal deaths world-wide. Tranexamic acid (TXA), an antifibri-nolytic agent, effectively reduces surgical bleeding, but the efficacy of oral versus in-travenous (IV) TXA in cesarean deliveries is not well-studied. Objective: This study compares the effec-tiveness and safety of preoperative oral ver-sus IV TXA in reducing intraoperative blood loss during elective lower segment cesarean sections (LSCS). Patients and Methods: We randomly as-signed 140 women scheduled for LSCS into two groups: the IV TXA group received 1 g of TXA intravenously at anesthesia induc-tion, while the oral TXA group received 2 g orally one hour before surgery. The primary outcome was estimated blood loss (EBL), with secondary outcomes including exces-sive blood loss (>1000 mL), blood transfu-sion needs, uterotonic usage, and side effects. Results: The oral TXA group experienced significantly higher average blood loss than the IV group, measured through surgical towels, suction containers, and estimation formulas. No significant differences in post-partum hemorrhage rates or transfusion needs were observed, and both TXA forms showed no adverse maternal or fetal outcomes. Conclusion: Oral TXA led to greater intra-operative blood loss compared to IV TXA, but both methods were equally effective in preventing excessive postpartum bleeding. TXA was safe for mothers and fetuses re-gardless of administration route.