Effect of tranexamic acid combined with strap hysterorrhaphy on postpartum hemorrhage caused by uterine fatigue

Objective To investigate the effect of tranexamic acid combined with B-Lynch suture on coagulation function and immune function in patients with uterine atonic postpartum hemorrhage.

Methods A total of 106 patients with uterine atonic postpartum hemorrhage from June 2020 to June 2022 were selected as study subjects and randomly divided into control group (53 cases) and observation group (53 cases) according to the random number table method. The control group was treated with B-Lynch suture, while the observation group was treated with tranexamic acid combined with B-Lynch suture. The operation time, intraoperative blood loss, 24-hour postpartum blood loss, 24-hour postpartum hemoglobin level, and adverse outcomes of the two groups were observed. The coagulation function, immune function, and ovarian function of the two groups were compared at different time points.

Results Compared with the control group, the operation time of the observation group was shorter, and the intraoperative blood loss and 24-hour postpartum blood loss were lower (P < 0.05). At 24 hours postpartum, the hemoglobin levels of both groups were lower than those before childbirth, but the observation group was higher than the control group (P < 0.05). Compared with the control group, the incidence of adverse outcomes in the observation group was lower (P < 0.05). At 24 hours postpartum, the thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) of both groups were longer than those before childbirth, while the fibrinogen (FIB) levels were lower than those before childbirth (P < 0.05). Compared with the control group, TT, APTT, and PT of the observation group were shorter, and the FIB level was higher (P < 0.05). At 24 hours postpartum, the CD4+ levels of both groups were lower than those before childbirth, while the CD8+ levels were higher than those before childbirth(P < 0.05). However, compared with the control group, the CD4+ level of the observation group was higher, and the CD8+ level was lower (P < 0.05). At 42 days postpartum, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) in both groups were higher than those before childbirth, while the peak systolic velocity (PSV) and pulsatility index (PI) were lower than those before childbirth (P < 0.05). However, compared with the control group, the levels of FSH, LH, and E₂ in the observation group were lower, while the PSV and PI were higher (P < 0.05). There was no statistically significant difference in the resistance index (RI) between the two groups before childbirth and at 42 days postpartum (P>0.05).

Conclusion The combination of tranexamic acid and B-Lynch suture can effectively reduce the amount of bleeding in patients with uterine atonic postpartum hemorrhage, improve coagulation function and immune function, protect ovarian function, and reduce the incidence of adverse outcomes in postpartum women.