Gedeno Gelebo Kanbiro, Mulugeta Hailemariam, Mossie Addisu, Geremu Kuchulo, Darma Bahiru
Department of Anesthesia, College of Medicine and Health Science, Arba Minch University, Arba Minch.
Department of Anesthesia, College of Medicine and Health science, Dilla University, Dilla.
Ann Med Surg (Lond). 2023 Nov 27;86(1):353-360. doi: 10.1097/MS9.0000000000001560. eCollection 2024 Jan.
Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. Early recognition and appropriate treatment are crucial for managing postpartum haemorrhage.
This literature review aimed to evaluate the efficacy of tranexamic acid in the prevention and treatment of postpartum haemorrhage in resource-limited settings.
This literature review was conducted based on the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A computerized systematic search of the MEDLINE (PubMed), Google Scholar, and Cochrane databases using a combination of the following Medical Subject Headings (MeSH) terms for PubMed: [(obstetric haemorrhage OR postpartum haemorrhage OR massive obstetric haemorrhage) AND (tranexamic acid OR antifibrinolytic drugs) AND (prophylaxis OR prevention) AND (management OR treatment) AND (resource-limited settings OR resource-limited area OR developing countries)] to find articles published in English since 2010.
Studies on the obstetric population who underwent vaginal or caesarean delivery, comparing the use of tranexamic acid versus placebo (or no treatment) for treatment (or prevention) of postpartum haemorrhage with the outcome of postpartum haemorrhage rate, blood transfusion requirements, uterotonics requirements, hysterectomy, or mortality were included.
In total, 5315 articles were identified. Following the elimination of duplicates, the methodological quality of 15 studies was evaluated independently, with eligibility determined based on the inclusion and exclusion criteria, as well as outcome variables. Finally, eight articles were included in the review.
This review provides evidence that the administration of tranexamic acid has the potential to decrease the need for blood transfusion, incidence of postpartum haemorrhage, demand for supplementary uterotonics, and maternal morbidity and mortality with marginal adverse effects. Healthcare systems must develop and implement interventions that involve the use of tranexamic acid for the treatment of postpartum haemorrhage in resource-limited settings.
产后出血是全球孕产妇发病和死亡的主要原因。早期识别和适当治疗对于管理产后出血至关重要。
本文献综述旨在评估氨甲环酸在资源有限环境中预防和治疗产后出血的疗效。
本文献综述依据系统评价和Meta分析的首选报告项目（PRISMA）指南进行。使用以下针对PubMed的医学主题词（MeSH）术语组合，对MEDLINE（PubMed）、谷歌学术和Cochrane数据库进行计算机化系统检索：[（产科出血或产后出血或大量产科出血）AND（氨甲环酸或抗纤溶药物）AND（预防或 prophylaxis）AND（管理或 treatment）AND（资源有限环境或资源有限地区或发展中国家）]，以查找自2010年以来发表的英文文章。
纳入对接受阴道分娩或剖宫产的产科人群进行的研究，比较使用氨甲环酸与安慰剂（或不治疗）治疗（或预防）产后出血，并以产后出血率、输血需求、宫缩剂需求、子宫切除术或死亡率为结局指标。
共识别出5315篇文章。在消除重复项后，独立评估了15项研究的方法学质量，并根据纳入和排除标准以及结局变量确定其是否合格。最后，8篇文章纳入本综述。
本综述提供的证据表明，使用氨甲环酸有可能减少输血需求、产后出血发生率、补充宫缩剂的需求以及孕产妇的发病率和死亡率，且副作用较小。医疗保健系统必须制定并实施相关干预措施，在资源有限的环境中使用氨甲环酸治疗产后出血。
