FACULTY OF CLINICAL SCIENCES
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Item Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial(The Wellcome Trust, 2018) Shakur-Still, H.; Roberts, I.; Fawole, B.; Kuti, M.; Olayemi, O. O.; Bello, A.; Huque, S.; Ogunbode, O.; Kotila, T.|; Aimakhu, C.; Okunade, O. A.; Olutogun, T.; Adetayo, C. O.; Dallaku, K.; Mansmann, U.; Hunt, B. J.; Pepple, T.; Balogun, E.Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests.Item Randomized controlled trial comparing 200 µg and 400 µg sublingual misoprostol for prevention of primary postpartum hemorrhage.(2016) Ugwu, I. A.; Oluwasola, T. A. O.; Enabor, O. O.; Anayochukwu-Ugwu, N. N.; Adeyemi, A. B.; Olayemi, O. O.Objective: To compare efficacy and adverse effects of 200 μg and 400μgmisoprostol for prevention of postpartum hemorrhage (PPH). Methods: In a randomized control trial, women with term singleton pregnancies in active labor attending University College Hospital, Ibadan, Nigeria, were enrolled between July 2011 and February 2012. Participants were randomly assigned using random numbers (block size four) to receive 200 μg or 400 μg sublingual misoprostol after delivery of the anterior shoulder, alongside intravenous oxytocin. Investigators were masked to group assignment, but participants were not. The primary outcomes were blood loss up to 1 h after delivery, PPH (blood loss ≥500 mL), and adverse effects. Results: Overall, 62 patients were assigned to each group. No significant differences between the 200-μg and 400-μg groups were recorded in mean per partum blood loss (307 ± 145 mL vs 296 ± 151 mL; P =0.679) and PPH occurrence (5 [8.1%] vs 6 [9.7%] women; P=0.752). Noticeable adverse effects were reported by 16 (25.8%) women in the 200-μg group and 42 (67.7%) in the 400-μg group (P b 0.001). Risk of shivering was significantly lower with 200 μg than 400 μg (relative risk 0.33, 95% confidence interval 0.19–0.58). Conclusion: Blood loss and PPH occurrence did not differ by misoprostol dose, but a 200-μg dose was associated with a reduction in adverse effects.Item Utility of serum cystatin C as a predictive marker for preeclampsia in pregnant Nigerian women(Society of Gynaecology and Obstetrics of Nigeria (SOGON), 2019) Oluwasola, T. A. O.; Adedapo, K. S.; Odukogbe, A. A.; Olayemi, O. O.