Reducing Blood Loss During Cesarean Hysterectomy for Placenta Accreta Spectrum
Status:
Completed
Trial end date:
2021-08-01
Target enrollment:
Participant gender:
Summary
PAS is an obstetrics condition that is closely linked with massive obstetrical hemorrhage
with a varied incidence about once in every 533 live births. It is considered one of the
causes of massive transfusion (>4 units of packed red blood cells) and cesarean hysterectomy.
It is estimated that peripartum hysterectomies are performed in approximately0.08% of all
deliveries. A large study from the United Kingdom noted that 38% were a result of PAS. More
recently, population-based analyses show that PAS is the indication for the majority of
peripartum hysterectomies.
Bleeding at the time of peripartum hysterectomy for PAS is often substantial. Nearly 90% of
patients need blood products, while 38% of patients need a massive blood transfusion.
There is a 30% risk of an ICU admission, thromboembolic disease, readmission, reoperation,
poor wound healing, and a reported rate of surgical re-exploration ranging from 4% to 33%.
The risk of maternal death reported being as high as 7% (although less in most recent series)
Therefore, adequate homeostatic techniques are essential. Currently, surgical hemostasis can
be secured by a variety of methods, including mechanical sutures (or clamping), electric
coagulation, ultrasonically activated scalpel or drugs.
TA is a lysine analog which acts as an antifibrinolytic via competitive inhibition of the
binding of plasmin and plasminogen to fibrin. The rationale for its use in the reduction of
blood loss depending on the implication of the coagulation and fibrinolysis processes .
However, concerns about possible thromboembolic events with the parental administration of TA
has stimulated increasing interest in its topical Use