- Effectiveness of tranexamic acid in the therapy of bleeding in the first trimester of pregnancy
Effectiveness of tranexamic acid in the therapy of bleeding in the first trimester of pregnancy
HEALTH OF WOMAN. 2018.4(130):59–62; doi 10.15574/HW.2018.130.59
Romanenko T. G. , Sulimenko O. M.
Shupyk National Medical Academy of Postgraduate Education, Kiev
The objective: to study the effectiveness of hemostatic therapy with tranexamic acid in pregnant women with miscarriage that started.
Materials and methods: The study group included 110 pregnant women with a miscarriage that began with the onset of retrochoric hematoma, from 5 to 22 weeks of gestation. The main group was 60 pregnant women who received hemostatic therapy with the drug tranexamic acid Vidanol in a daily dose of 1000–1500 mg until stopping the bleeding. The comparison group consisted of 50 pregnant women who received standard hemostatic therapy with etamsylatum. On ultrasound, retrochorionic / retroplacental hematomas were noted in 27 women of the main group (45%) and 22 patients in the comparison group (44%), extramembrane hematomas were diagnosed in 8 (13.3%) and 9 (18%) women, respectively. Placenta presentation was observed in 7 (11.7%) and 8 (16%) women of both groups, respectively. In the rest of pregnant women there was a bloody discharge from the genital tract as a result of detachment of the chorion / placenta or membranes without formation of hematoma. The obtained data are processed by the statistical method using the Microsoft Excel computer program.
Results. Stopping bleeding with the use of tranexamic acid averaged over 2 days from the start of therapy, the duration of bleeding was 2.1±0.2 days, whereas in the comparison group, the duration of bleeding was significantly higher than 5.7±0.3 (p<0,01). The need for inpatient treatment was in the main group of 9.7±0.8 bed-days and 15.6±2.7 bed-days, respectively (p<0.05). When using the drug tranexamic acid, the organization and resorption of hematomas in the uterus occurred in a shorter time – 19 of 35 (54.3%) women in the primary group and 10 in 31 (32.3%) women in the comparison group. The total absence of hematoma is noted in the main group for 1.2±0.4 weeks, in the comparison group for 4.8±0.5 weeks (p<0.05).
Conclusion. The use of tranexamic acid, as hemostatic therapy in pregnant women with a miscarriage, significantly reduces the duration of bleeding, promotes the accelerating the organization and resorption of intrauterine hematomas, reduces the duration of inpatient treatment.
Key words: pregnancy, miscarriage, risk of miscarriage, retrochorionic hematoma, bleeding in the first trimester of pregnancy.
1. Baev OR. 2011. Profilaktika krovotecheniy v poslerodovom i rannem poslerodovom periode. Aktivnaya ili vyizhidatelnaya taktika? 6:27–30.
2. Kulikov AV, Martirosyan SV, Oboskalova TA. 2010. Protokol neotlozhnoy pomoschi pri krovotechenii v akusherstve. Metodicheskie rekomendatsii. Ekaterinburg.
3. De Lange NM, Lancé MD, de Groot R, Beckers EA, Henskens YM, Scheepers HC. 2012, Jul. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv. 67(7):426–435. https://doi.org/10.1097/OGX.0b013e3182605861; PMid:22926249
4. Lindoff C, Rybo G, Astedt B. 1993. Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications. Thromb. Haemost. 2, 70(2):238–240.
5. Onwuemene O, Green D, Keith L. 2012, Oct. Postpartum hemorrhage management in 2012: predicting the future. Int J Gynaecol Obstet. 119(1):3–5. https://doi.org/10.1016/j.ijgo.2012.07.001; PMid:22867727
6. Peitsidis P, Kadir RA. 2011. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother. 12(4):503–516. https://doi.org/10.1517/14656566.2011.545818; PMid:21294602
7. Su LL, Chong YS. 2012, Feb. Massive obstetric haemorrhage with disseminated intravascular coagulopathy. Best Pract Res Clin Obstet Gynecol. 26(1): 77–90. https://doi.org/10.1016/j.bpobgyn.2011.10.008; PMid:22101177
8. Tower CL, Regan L. 2001. Intrauterine haematomas in a recurrent miscarriage population. Human Reproduction. 16(9):2005–2007. https://doi.org/10.1093/humrep/16.9.2005
9. Van Oppenraaij RHF, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG and Exalto N. 2009. ESHRE Special Interest Group for Early Pregnancy (SIGEP) Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Human Reproduction Update. 15(4):409–421. https://doi.org/10.1093/humupd/dmp009; PMid:19270317