Adjuvant Intravenous Tranexamic Acid Increases the Efficacy of Sublingual Misoprostol Compared with Carbetocin to Reduce the Amount of Blood loss During Cesarean Delivery: A Randomized Clinical Trial

 To determine the safety and adequacy of intravenous (IV) carbetocin compared to IV tranexamic acid (TA) plus sublingual misoprostol in reducing hemorrhage during and following cesarean delivery (CD) in women with at least one risk factor for postpartum hemorrhage.

 This clinical study was randomized. We randomly assigned 400 term pregnant women who were candidates for elective CD to receive either a 100 μg intravenous infusion of carbetocin or 1gm. IV TA along with 400 μg of sublingual misoprostol after delivery. Comparing the quantity of blood loss at and six hours following a CD was the primary result. We also disclosed the necessity for any extra medications and any adverse drug reactions.

 When compared to the misoprostol plus tranexamic acid group, the carbetocin group's total mean blood loss was considerably higher (829.7 293.3 mL vs. 609.33 211.5 mL; P = 0.0001). Following the administration of carbetocin and misoprostol with TA, respectively, 9.5% and 26.5% of patients required further uterotonics treatment (P = 0.0001). When compared to the carbetocin group, the misoprostol group's side effects, such as a bad taste in the mouth and fever, were much greater (P = 0.0001).

 When it comes to minimizing overall blood loss during and after CD, IV tranexamic acid combined with sublingual misoprostol is superior to IV carbetocin.