Therapeutic effect of carboprost tromethamine combined with tranexamic acid for postpartum hemorrhage in repeated cesarean delivery

Ma Yaomin; Tang Guangying; Liang Hongna

doi:10.3969/j.issn.1672-8157.2025.06.029

Abstract：Objective To explore the preventive value of carboprost tromethamine combined with tranexamic acid for postpar-tum hemorrhage of scarred uterus in repeated cesarean delivery.Methods A total of 176 pregnant women with scarred uterus who underwent repeated cesarean delivery in the Department of Obstetrics and Gynecology,Luoyang Petrochemical Hospital from Febru-ary 2022 to August 2024 were prospectively selected as the research subjects and divided into the combination group and the control group by random number table method,with 88 cases in each group.The patients in the control group were treated with carboprost tromethamine injection combined with oxytocin,and the patients in the combination group were treated with carboprost tromethamine injection combined with tranexamic acid.The dosage of carboprost tromethamine during the operation,the incidence of postpartum hemorrhage,the amount of bleeding 2 and 24 hours after delivery,the recovery status(the rate of uterine fundal descent,the duration of lochia,hospital stays),changes in coagulation indicators(prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D))before and 24 h after surgery were compared between the two groups,and the incidence of adverse reactions of the two groups was statistically analyzed.Results The dosage of carboprost tromethamine in the combination group((508.93±41.77)μg)was lower than that in the control group((574.62±46.80)μg),and the difference was statistically significant(t=9.824,P<0.001).The incidence of postpartum hemorrhage in the control group was 19.32%(17/88),and that in the combination group was 7.95%(7/88),with a statistically significant difference between the two groups(χ2=4.825,P=0.028).The amount of bleed-ing 2 and 24 hours after delivery and the duration of continuous bleeding in the combination group((45.46±10.08)mL,(308.95±50.21)mL,(14.17±3.91)days,respectively)were lower than those in the control group((68.73±12.62)mL,(441.19±55.36)mL,(21.31±4.25)days,respectively),and the differences were all statistically significant(t=13.515,16.598,11.598,all P<0.001).In terms of postpartum recovery,the duration of lochia,the rate of uterine fundus descent and hospital stays in the combination group((14.27±3.88)days,(1.18±0.20)cm·d-1,(6.64±1.58)days,respectively)were better than those in the control group((21.74±4.36)days,(0.61±0.15)cm·d-1,(9.68±1.75)days,respectively),and the differences were statistically significant(t=12.006,-21.388,12.095,all P<0.001).In terms of coagulation indexes,the APTT and PT levels at 24 hours after surgery in the combination group((25.38±4.92)s,(10.92±1.18)s,respectively)were lower than those in the control group((32.09±4.64)s,(13.59±1.22)s,respectively),and the dif-ferences were statistically significant(t=9.308,14.757,both P<0.001),and the FIB and D-D levels in the combination group((4.26±0.51)g·L-1,(3.72±0.28)mg·L-1,respectively)were higher than those in the control group((3.39±0.33)g·L-1,(3.04±0.39)mg·L-1,re-spectively),and the differences were statistically significant(t=13.435,-13.287,both P<0.001).The incidence of adverse reactions in the combination group was 5.68%(5/88),and that in the control group was 4.55%(4/88),with no statistically significant difference between the two groups(χ2=0.000,P=1.000).Conclusion Carboprost tromethamine combined with tranexamic acid can synergis-tically enhance uterine contractions and inhibit the fibrinolytic system,effectively reduce postpartum hemorrhage in pregnant women with scarred uterus who underwent repeated cesarean delivery,improve coagulation function and has good safety.