A Single Large dose of tranexamic acid before vaginal delivery: Is it beneficial?

Background: many factors are attributed in the management of postpartum hemorrhage after vaginal delivery.Objective: to assess the efficacy and safety of a single large dose of intravenous tranexamic acid in reducing postpartum blood loss after vaginal delivery.Subjects and Methods: this is a multicentric prospective randomized double blind placebo controlled trial.240 pregnant women were randomized to receive either 60 mg/kg of TA (n=120) or placebo (n=120) intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from placental delivery to 2 hours postpartum and adverse effects of were observed.Results: the mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group(241.5 � 82.7 versus 322.8 � 127.4, respectively; p < 0.001),and the proportion of women in the tranexamic acid group who had an estimated blood loss 500 mL was significantly lower than in the placebo group ( 5 [4.2%] versus 18 [15%], relative risk [RR]=0.30; 95% confidence interval [CI] 0.11 to 0.78; P<0.05).Maternal and neonatal outcomes did not differ significantly between both groups.Conclusion: A single large dose of tranexamic acid administrated intravenously before vaginal delivery significantly reduces the amount of postpartum blood loss and contributes to prevention of PPH. Adverse effects were only mild and transient. Thus, tranexamic acid can be used safely and effectively to reduce bleeding after vaginal delivery

An evaluation of intra- and post-operative blood loss in total hip arthroplasty at the national orthopaedic hospital, Lagos

Background: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. Patients and Methods: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. Results: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P< 0.001 and r = 0.517, P< 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). Conclusion: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time