comparison of the effect of tranexamic acid and misoprostol on blood loss during and after cesarean section: a randomized clinical trial

Background: one of the methods proposed for the reduction of blood loss during and after cesarean section is the use of such drugs as tranexamic acid and misoprostol. therefore, the present study aimed to compare the effect of tranexamic acid and misoprostol on blood loss during and after cesarean section. methods: this randomized clinical trial was performed in dr. ali shariati and persian gulf hospitals of bandar abbas, iran, between 2015 and 2016. the study population included all candidates for the cesarean section. a total of 300 pregnant women aged 18-40 years with a gestational age of 37-42 weeks were included and assigned to three groups (n=100 in each group): group a received tranexamic acid, group b received misoprostol, and group c received 200 cc normal saline. during cesarean section, all patients received 20 and 30 units of oxytocin, respectively. the level of blood loss during the operation was determined after measuring the whole blood volume suctioned after the removal of the placenta, as well as differences in the weight of bloody sterile pads and surgical sheets before and after the operation. results: based on the results, the mean scores of hemoglobin before the operation were obtained at 11.96±1, 11.62±1.21, and 12.28±1.26mg/dl in the tranexamic acid group, the misoprostol group, and the placebo group, respectively, demonstrating a statistically significant difference (p=0.001). postoperative hemoglobin level was reduced about 1.02±0.35 (10.9±0.99 mg/dl) in the tranexamic acid group, 1.19±0.52 (10.46±1.04 mg/dl) in the misoprostol group, and 1.36±0.50 (10.93±1.34 mg/dl) in the placebo group. there was a significant difference among the three groups in the amount of blood loss during and the first two hours after the operation (p<0.001). according to the post-hoc test analysis, there were significant differences between the two groups (p<0.001). conclusion: as evidenced by the obtained results, both medicines are effective in reducing the amount of blood loss during and after cesarean section; nonetheless, misoprostol is more effective than tranexamic acid.