Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Randomized Controlled Trial Comparative Study
Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate.
Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). ⋯ In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.
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The Royal College of Anaesthetists have set the standard that 85% of emergency caesarean sections should be carried out under regional anaesthesia. Reducing the frequency of caesarean sections carried out under general anaesthesia may serve to reduce maternal morbidity and mortality, which has been shown over recent years. ⋯ The proportion carried out under regional anaesthesia was less than recommended. Despite a longer time taken to induce anaesthesia there was no increase in adverse fetal outcome, supporting the use of regional anaesthesia wherever possible to keep maternal complications to a minimum.