Major obstetric haemorrhage

Tranexamic Acid Use in Obstetric Hemorrhage: Knowledge and Attitude Among Jordanian Obstetricians and Gynecologists

AIM

Tranexamic acid (TXA) use in obstetric hemorrhage has been shown to decrease both maternal mortality and morbidity. This study aimed to explore the knowledge and attitudes of Jordanian obstetricians and gynecologists regarding the use of TXA in obstetric bleeding cases, as well as to identify factors that affect decision-making processes and emphasize the significance of TXA in enhancing maternal health outcomes.

METHODOLOGY

This study used a cross-sectional design and a structured questionnaire to gather data from a convenience sample of 1000 Jordanian obstetricians.

RESULTS

Most participants used TXA to address obstetric hemorrhage, with medical training being the primary source of knowledge about TXA for (113/166) 68.1% of respondents. Awareness of TXA's potential benefits was high but some misconceptions existed. Approximately (96/166) 57.8% of the participants were aware of the recommended dosage regimen, and (61/166) 36.7% emphasized the importance of timing of administration. Knowledge of potential side effects was notable, with (55/166) 33.1% aware of life-threatening side effects, such as pulmonary embolism and deep vein thrombosis. Concerns regarding barriers to implementation included the absence of strict guidelines (54.8%) and drug availability ( 91/166; 54.8%). However, (64/166) 38.6% expressed confidence in the effective use of TXA for obstetric hemorrhage treatment. The majority of respondents (154/166; 92.8%) considered additional education and training on TXA use to be important in managing obstetric hemorrhage.

CONCLUSION

Jordanian obstetricians have used TXA in cases of obstetric hemorrhage despite their experience and knowledge based only on limited resources; the need for national guidelines on when and how to use TXA in obstetric practice is of great importance and got vast support from the Jordanian obstetricians.

Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial

OBJECTIVE

To test equivalence of two doses of intravenous iron (ferric carboxymaltose) in pregnancy.

DESIGN

Parallel, two-arm equivalence randomised controlled trial with an equivalence margin of 5%.

SETTING

Single centre in Australia.

POPULATION

278 pregnant women with iron deficiency.

METHODS

Participants received either 500 mg (n=152) or 1000mg (n=126) of intravenous ferric carboxymaltose in the second or third trimester.

MAIN OUTCOME MEASURES

The proportion of participants requiring additional intravenous iron (500mg) to achieve and maintain ferritin >30ug/L (diagnostic threshold for iron deficiency) at 4 weeks post-infusion, and at 6 weeks, and 3-, 6- and 12-months postpartum. Secondary endpoints included repeat infusion rate, iron status, birth, and safety outcomes.

RESULTS

The two doses were not equivalent within a 5% margin at any timepoint. At 4 weeks post infusion, 26/73 (36%) participants required a repeat infusion in the 500 mg group compared with 5/67 (8%) in the 1000 mg group (difference in proportions, 0.283 95% confidence interval (0.177, 0.389)). Overall, participants in the 500 mg arm received twice the repeat infusion rate (0.81 (SD= 0.824 vs 0.40 (SD= 0.69), rate ratio 2.05, 95% CI (1.45, 2.91)).

CONCLUSIONS

Administration of 1000 mg ferric carboxymaltose in pregnancy maintains iron stores and reduces the need for repeat infusions. A 500 mg dose requires ongoing monitoring to ensure adequate iron stores are reached and sustained.